Provider Demographics
NPI:1720230337
Name:ANNULYSSE, ISABELITA (CRNP)
Entity Type:Individual
Prefix:
First Name:ISABELITA
Middle Name:
Last Name:ANNULYSSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARIA ISABELITA
Other - Middle Name:
Other - Last Name:AVISO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3735 NAZARETH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-258-2826
Practice Address - Fax:610-258-9377
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12970ECNMedicare PIN