Provider Demographics
NPI:1992127120
Name:JUNG, MELANIE ELIZABETH ASCHE (CRNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELIZABETH ASCHE
Last Name:JUNG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ELIZABETH
Other - Last Name:ASCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-856-2128
Practice Address - Fax:774-443-2043
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013079363LF0000X
MARN282958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily