1861216343 NPI number — MRS. MELISSA KLEMICK RN, CDCES

Table of content: MRS. MELISSA KLEMICK RN, CDCES (NPI 1861216343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861216343 NPI number — MRS. MELISSA KLEMICK RN, CDCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEMICK
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CDCES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
MELISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861216343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PEARTREE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15009-1954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-749-4252
Provider Business Mailing Address Fax Number:
724-773-7641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PEARTREE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-1954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-749-4252
Provider Business Practice Location Address Fax Number:
724-773-7641
Provider Enumeration Date:
11/12/2024

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: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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