1023346434 NPI number — MRS. MELANIE ANNE ELEANOR GREM L.S.W.

Table of content: MRS. MELANIE ANNE ELEANOR GREM L.S.W. (NPI 1023346434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023346434 NPI number — MRS. MELANIE ANNE ELEANOR GREM L.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREM
Provider First Name:
MELANIE
Provider Middle Name:
ANNE ELEANOR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHUMAKER
Provider Other First Name:
MELANIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023346434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 CENTURY DRIVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-982-2926
Provider Business Mailing Address Fax Number:
717-795-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 CENTURY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-795-0330
Provider Business Practice Location Address Fax Number:
717-795-0407
Provider Enumeration Date:
11/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: SW127843 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)