Healthcare Provider Details

I. General information

NPI: 1669411393
Provider Name (Legal Business Name): MELISSA A CALLAHAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A HENOFER CRNP

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EXTON CMNS
EXTON PA
19341-2450
US

IV. Provider business mailing address

320 EXTON CMNS
EXTON PA
19341-2450
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-6609
  • Fax: 866-610-4542
Mailing address:
  • Phone: 866-268-6609
  • Fax: 866-610-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP006182C
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberTP006181H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: