Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 111868 | NE |
NPI | 1073996021 |
---|---|
Provider Name | Kelli L. Pirruccello |
First Address | Omaha, NE 68103-2797 |
Second Address | Elkhorn, NE 68022-3974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100258661-00 | (05) | NE |
1073996021 | (05) | IA |