Healthcare Provider Details

I. General information

NPI: 1225814619
Provider Name (Legal Business Name): MELISSA LEE HERN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7571 ROUTE 54
BATH NY
14810-9504
US

IV. Provider business mailing address

7571 ROUTE 54
BATH NY
14810-9504
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-8522
  • Fax:
Mailing address:
  • Phone: 607-776-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN716355
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number592825-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: