Provider Demographics
NPI:1588895817
Name:KELLY-TRALIES, MARIE C (CRNP-BC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:KELLY-TRALIES
Suffix:
Gender:
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:C
Other - Last Name:KELLY-TRALIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP-BC
Mailing Address - Street 1:8765 STENTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8317
Mailing Address - Country:US
Mailing Address - Phone:215-836-2440
Mailing Address - Fax:215-836-2448
Practice Address - Street 1:8765 STENTON AVENUE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8317
Practice Address - Country:US
Practice Address - Phone:215-836-2440
Practice Address - Fax:215-836-2448
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010370363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health