Provider Demographics
NPI:1154518280
Name:KNIBBS, MELIDA DELCINA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MELIDA
Middle Name:DELCINA
Last Name:KNIBBS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 WEST 181 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8779
Mailing Address - Country:US
Mailing Address - Phone:347-756-6000
Mailing Address - Fax:
Practice Address - Street 1:521 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5102
Practice Address - Country:US
Practice Address - Phone:347-756-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380894-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily