Provider Demographics
NPI:1063201465
Name:KULBIS, MELISSA (AGNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KULBIS
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BOLGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1961 NUMBER 10 RD
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9356
Mailing Address - Country:US
Mailing Address - Phone:267-347-9089
Mailing Address - Fax:
Practice Address - Street 1:12073 TECH RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7873
Practice Address - Country:US
Practice Address - Phone:267-347-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026962363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology