Provider Demographics
NPI:1932538246
Name:VELLA-CAMILLERI, ANDREA LISA (CRNA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LISA
Last Name:VELLA-CAMILLERI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MIDCREST CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1604
Mailing Address - Country:US
Mailing Address - Phone:443-791-1474
Mailing Address - Fax:
Practice Address - Street 1:5 MIDCREST CT
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-1604
Practice Address - Country:US
Practice Address - Phone:443-791-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered