Provider Demographics
NPI:1427114479
Name:MORELLI, ALICE MARIAN (CNP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARIAN
Last Name:MORELLI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3358
Mailing Address - Country:US
Mailing Address - Phone:330-726-3204
Mailing Address - Fax:330-729-9316
Practice Address - Street 1:715 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3358
Practice Address - Country:US
Practice Address - Phone:330-726-3204
Practice Address - Fax:330-729-9316
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0606096363L00000X
OHCOA08904NP364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3139295Medicaid
OHMONP23471Medicare UPIN
OH3139295Medicaid