Provider Demographics
NPI:1285887778
Name:CALIANNO, CAROL (CRNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CALIANNO
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 SWAN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1129
Mailing Address - Country:US
Mailing Address - Phone:215-206-7079
Mailing Address - Fax:215-707-8598
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:SUITE 410 ZONE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-539-0021
Practice Address - Fax:215-707-8598
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009977363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health