Individual
MRS. MAUREEN G. BOCCELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CDE
Contact information
Practice address
375 RED COAT LN, WAYNE, PA 19087-1338
(610) 975-9208
Mailing address
375 RED COAT LN, WAYNE, PA 19087-1338
(610) 975-9208
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN002035
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12204152
CAQH
PA
01
—
3830821000
IBC
PA
Enumeration date
01/06/2011
Last updated
04/23/2013
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