Provider Demographics
NPI:1811154263
Name:CARAVELLO, MARY E (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CARAVELLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4715 VIEWRIDGE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1680
Mailing Address - Country:US
Mailing Address - Phone:800-257-8715
Mailing Address - Fax:858-874-8212
Practice Address - Street 1:4715 VIEWRIDGE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1680
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:858-874-8212
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00182000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health