Provider Demographics
NPI:1962727081
Name:RAFFAELE, MELISSA ELAINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:RAFFAELE
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 1:1414 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-6326
Mailing Address - Country:US
Mailing Address - Phone:814-946-1655
Mailing Address - Fax:
Practice Address - Street 1:1414 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-6326
Practice Address - Country:US
Practice Address - Phone:814-946-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG-0000522363LF0000X
PASP028345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily