Provider Demographics
NPI:1922558741
Name:MAMPALLIL, LENI SG (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LENI
Middle Name:SG
Last Name:MAMPALLIL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 PENNELL ROAD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014
Mailing Address - Country:US
Mailing Address - Phone:610-891-9277
Mailing Address - Fax:610-891-7778
Practice Address - Street 1:200 E STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-891-9277
Practice Address - Fax:610-891-7778
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRSP016853363LP2300X
PARN554509372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No372500000XNursing Service Related ProvidersChore Provider