1275606527 NPI number — MELISSA A HORELL RN, BSN

Table of content: MELISSA A HORELL RN, BSN (NPI 1275606527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275606527 NPI number — MELISSA A HORELL RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORELL
Provider First Name:
MELISSA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
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:
1275606527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 WALTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-942-0380
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 LAKEMONT PARK BLVD.
Provider Second Line Business Practice Location Address:
NFP
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-942-1903
Provider Business Practice Location Address Fax Number:
814-505-1100
Provider Enumeration Date:
11/16/2006

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: 163W00000X , with the licence number:  RN271147L , 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: 1015943420001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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