Provider Demographics
NPI:1386820322
Name:ANCELLOTTI, LORETTA (FNP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:ANCELLOTTI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HOSPITAL DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4533
Mailing Address - Country:US
Mailing Address - Phone:707-463-8000
Mailing Address - Fax:707-462-1111
Practice Address - Street 1:487 S MAIN ST
Practice Address - Street 2:SUITE 122
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5315
Practice Address - Country:US
Practice Address - Phone:707-263-4360
Practice Address - Fax:707-463-4036
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15237363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care