Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP007424 | PA |
NPI | 1225001142 |
---|---|
Provider Name | Nelson Anthony Iannuzzi |
First Address | Scranton, PA 18510-1624 |
Second Address | Scranton, PA 18510-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SP007424 | CRNP LICENSE (01) | PA |