Provider Demographics
NPI:1063092591
Name:TEETSEL, MELISSA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:TEETSEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 STATE ROUTE 3009
Mailing Address - Street 2:
Mailing Address - City:MESHOPPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18630-8384
Mailing Address - Country:US
Mailing Address - Phone:570-814-1984
Mailing Address - Fax:
Practice Address - Street 1:155 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3401
Practice Address - Country:US
Practice Address - Phone:570-822-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN695396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse