Individual provider Active NPI

Christina Iannelli, FNP

  • Family Nurse Practitioner
  • Waxhaw, NC
National Provider Identifier
1790978609
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5003367 Issued in NC
Practice address
1142 N Broome St
Waxhaw, NC 28173-9378
Phone
(794) 843-4680
Fax
(704) 843-4680
NPI assigned
Aug 23, 2007
Last updated
Jan 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5003367 NC Primary

Addresses

Primary practice location

1142 N Broome St
Waxhaw, NC 28173-9378

Mailing address

1142 N Broome St
Waxhaw, NC 28173-9378
Phone (794) 843-4680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5003367NCMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1790978609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1142 N BROOME ST",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281739378",
            "telephone_number": "794-843-4680",
            "fax_number": "704-843-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1142 N BROOME ST",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281739378",
            "telephone_number": "794-843-4680",
            "fax_number": "704-843-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IANNELLI",
        "first_name": "CHRISTINA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5003367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.