Provider Demographics
NPI:1275170474
Name:BREWER, MELINA CHARRELL (CRNP)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:CHARRELL
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003
Mailing Address - Country:US
Mailing Address - Phone:717-868-2423
Mailing Address - Fax:717-674-6148
Practice Address - Street 1:742 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003
Practice Address - Country:US
Practice Address - Phone:717-868-2423
Practice Address - Fax:717-674-6148
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN661708163W00000X
PASP021251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037434230001Medicaid
PA942325OtherMEDICARE