Individual
MARY T CANELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
485 COLLIERS WAY, WEIRTON, WV 26062-5012
(304) 723-5400
(304) 723-5400
Mailing address
485 COLLIERS WAY, WEIRTON, WV 26062-5012
(304) 723-5400
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
57996
WV
363LF0000X
Family Nurse Practitioner
COA1171NP
OH
363LF0000X
Family Nurse Practitioner
Primary
SP011001
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109904
—
OH
05
—
1027635930001
—
PA
Enumeration date
11/18/2010
Last updated
05/13/2020
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