1205384989 NPI number — MRS. MELISSA LAUREN BEANS CRNP

Table of content: MRS. MELISSA LAUREN BEANS CRNP (NPI 1205384989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205384989 NPI number — MRS. MELISSA LAUREN BEANS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEANS
Provider First Name:
MELISSA
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205384989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 829641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-370-5296
Provider Business Mailing Address Fax Number:
215-230-3725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-0105
Provider Business Practice Location Address Fax Number:
215-345-0562
Provider Enumeration Date:
09/12/2016

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: 363LA2200X , with the licence number:  SP016553 , 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)





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