Provider Demographics
NPI:1528675733
Name:MINER, MARCELLA ALENE (DNP, APRN)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:ALENE
Last Name:MINER
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:ALENE
Other - Last Name:REBELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:IL
Mailing Address - Zip Code:61250-9615
Mailing Address - Country:US
Mailing Address - Phone:309-230-5183
Mailing Address - Fax:
Practice Address - Street 1:303 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-3042
Practice Address - Country:US
Practice Address - Phone:815-772-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily