Provider Demographics
NPI:1063930196
Name:KRAUSE, MELISSA (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15999 BERWICK TPKE
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:PA
Mailing Address - Zip Code:16925-9145
Mailing Address - Country:US
Mailing Address - Phone:1607-857-7903
Mailing Address - Fax:
Practice Address - Street 1:15999 BERWICK TPKE
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:PA
Practice Address - Zip Code:16925-9145
Practice Address - Country:US
Practice Address - Phone:607-857-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN303173164W00000X
NY323322164W00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse