Provider Demographics
NPI:1801367578
Name:MAMMARELLA, ANITA (CRNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MAMMARELLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HIGH VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MERTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19539-9727
Mailing Address - Country:US
Mailing Address - Phone:610-349-6937
Mailing Address - Fax:
Practice Address - Street 1:2500 BERNVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-378-2676
Practice Address - Fax:610-378-2679
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019693363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care