Provider Demographics
NPI:1346077930
Name:PELLICCIA, IRENE VIOLA
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:VIOLA
Last Name:PELLICCIA
Suffix:
Gender:F
Credentials:
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 278
Mailing Address - Street 2:
Mailing Address - City:SWANQUARTER
Mailing Address - State:NC
Mailing Address - Zip Code:27885-0278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 278
Practice Address - Street 2:
Practice Address - City:SWANQUARTER
Practice Address - State:NC
Practice Address - Zip Code:27885-0278
Practice Address - Country:US
Practice Address - Phone:954-829-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily