Provider Demographics
NPI:1134206105
Name:CICCARELLI, ROSEMARY CIAVOLA (ANP, PNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:CIAVOLA
Last Name:CICCARELLI
Suffix:
Gender:F
Credentials:ANP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1630
Mailing Address - Street 2:WESTFIELD STATE COLLEGE
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01086-1630
Mailing Address - Country:US
Mailing Address - Phone:413-572-5415
Mailing Address - Fax:413-572-5545
Practice Address - Street 1:577 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01086-1630
Practice Address - Country:US
Practice Address - Phone:413-572-5415
Practice Address - Fax:413-572-5545
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA92766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACINP3824Medicare ID - Type Unspecified