Provider Demographics
NPI:1669841615
Name:CAROSELLA, ANGELA S (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:CAROSELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:BLDG 2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-717-2211
Mailing Address - Fax:402-398-6688
Practice Address - Street 1:6818 GROVER ST STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3632
Practice Address - Country:US
Practice Address - Phone:402-390-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111895363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care