Provider Demographics
NPI:1285391169
Name:CAPPELLA, JESSICA L (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CAPPELLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7222
Mailing Address - Country:US
Mailing Address - Phone:610-733-3719
Mailing Address - Fax:
Practice Address - Street 1:5 SENTRY PKWY E STE 100
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2312
Practice Address - Country:US
Practice Address - Phone:215-371-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty