Provider Demographics
NPI:1306490701
Name:DUCHESNE, MELISSA ANN (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DUCHESNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 NORTH 3RD STREET
Mailing Address - Street 2:LANDIS BUILDING 7TH FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-585-4603
Mailing Address - Fax:717-703-0075
Practice Address - Street 1:2501 NORTH 3RD STREET
Practice Address - Street 2:LANDIS BUILDING 7TH FLOOR
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-585-4603
Practice Address - Fax:717-703-0075
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN660405163W00000X
PASP020649363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP020649Medicaid