Provider Demographics
NPI:1720438807
Name:YANNITELLI, KELLY (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:YANNITELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646-8906
Mailing Address - Country:US
Mailing Address - Phone:814-243-4123
Mailing Address - Fax:
Practice Address - Street 1:1333 PLANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8456
Practice Address - Country:US
Practice Address - Phone:855-265-8008
Practice Address - Fax:814-238-1650
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN331250L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse