Provider Demographics
NPI:1902065873
Name:ORELLA, JOHN DENNIS (FNPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DENNIS
Last Name:ORELLA
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5727
Mailing Address - Street 2:
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-0727
Mailing Address - Country:US
Mailing Address - Phone:907-384-6115
Mailing Address - Fax:907-384-6045
Practice Address - Street 1:BLDG 60710
Practice Address - Street 2:CAMP CARROLL
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-0727
Practice Address - Country:US
Practice Address - Phone:907-384-6115
Practice Address - Fax:907-384-6045
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18425163W00000X
AK515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse