Healthcare Provider Details

I. General information

NPI: 1851370308
Provider Name (Legal Business Name): MELISSA L HARTKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA L DICKER CRNA

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
KINGSTON NY
12401-4626
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3100N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 845-331-3131
  • Fax: 845-331-2530
Mailing address:
  • Phone: 914-909-9018
  • Fax: 914-909-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number340666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: