1356369003 NPI number — MELANIE ANN HEIMBACH BRAGIN CRNP

Table of content: MELANIE ANN HEIMBACH BRAGIN CRNP (NPI 1356369003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356369003 NPI number — MELANIE ANN HEIMBACH BRAGIN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIMBACH BRAGIN
Provider First Name:
MELANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
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:
HEIMBACH
Provider Other First Name:
MELANIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356369003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1068 W BALTIMORE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-826-9781
Provider Business Mailing Address Fax Number:
717-945-5177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-826-9781
Provider Business Practice Location Address Fax Number:
717-945-5177
Provider Enumeration Date:
07/18/2006

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:  SP016006 , 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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