1518000769 NPI number — MELISSA DIANE ZEGLEY RN, ANP

Table of content: KELLI MARIALEX CABALLERO (NPI 1588204226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518000769 NPI number — MELISSA DIANE ZEGLEY RN, ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEGLEY
Provider First Name:
MELISSA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALLADINE
Provider Other First Name:
MELISSA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN, MSN, ANP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518000769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 ALEXANDER SPRING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17015-6953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-245-2228
Provider Business Mailing Address Fax Number:
717-245-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 ALEXANDER SPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17015-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-245-2228
Provider Business Practice Location Address Fax Number:
717-245-0806
Provider Enumeration Date:
02/15/2007

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:  SP008196 , 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)

  • Identifier: 1026473240003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".