Individual
KELLYANN PATRICIA CIVILETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
403 E 34TH ST FL 3, NEW YORK, NY 10016-4972
(212) 263-8134
Mailing address
403 E 34TH ST FL 3, NEW YORK, NY 10016-4972
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
646983
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
308012
NY
Other
Enumeration date
10/18/2016
Last updated
11/14/2024
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