Provider Demographics
NPI:1528454717
Name:NARDIELLO, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NARDIELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BUONPASTORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1861 STURDY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8017
Mailing Address - Country:US
Mailing Address - Phone:219-548-0360
Mailing Address - Fax:219-548-0358
Practice Address - Street 1:295 NE GILMAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2906
Practice Address - Country:US
Practice Address - Phone:425-391-2500
Practice Address - Fax:425-391-6464
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001797A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant