Provider Demographics
NPI:1295737377
Name:ROCANELLI, LINDA (CRNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROCANELLI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N CHURCH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-3189
Mailing Address - Country:US
Mailing Address - Phone:570-455-5889
Mailing Address - Fax:570-455-9714
Practice Address - Street 1:668 N CHURCH ST STE 10
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-3189
Practice Address - Country:US
Practice Address - Phone:570-455-5889
Practice Address - Fax:570-455-9714
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN346142L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008078Medicare ID - Type Unspecified
PRS61038Medicare UPIN