Provider Demographics
NPI:1992099139
Name:HARRIS, MELISSA NICOLE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 WASHINGTON LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1625
Mailing Address - Country:US
Mailing Address - Phone:215-376-6801
Mailing Address - Fax:215-376-6805
Practice Address - Street 1:8101 WASHINGTON LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1625
Practice Address - Country:US
Practice Address - Phone:215-376-6801
Practice Address - Fax:215-376-6805
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN533946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse