Healthcare Provider Details

I. General information

NPI: 1538460167
Provider Name (Legal Business Name): MELISSA HANNON BAUMHOLTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MERION AVE
BRYN MAWR PA
19010-2859
US

IV. Provider business mailing address

101 N MERION AVE
BRYN MAWR PA
19010-2859
US

V. Phone/Fax

Practice location:
  • Phone: 610-526-7360
  • Fax:
Mailing address:
  • Phone: 610-526-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number331113-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: