Provider Demographics
NPI:1861903395
Name:AMORELLO, JAN (NP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:AMORELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1107
Mailing Address - Country:US
Mailing Address - Phone:508-427-2900
Mailing Address - Fax:
Practice Address - Street 1:818 OAK ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1107
Practice Address - Country:US
Practice Address - Phone:508-427-2900
Practice Address - Fax:508-427-2901
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily