Healthcare Provider Details

I. General information

NPI: 1073052312
Provider Name (Legal Business Name): MELINDA J. KOTTCAMP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N DUKE ST
LANCASTER PA
17602-2374
US

IV. Provider business mailing address

540 N DUKE ST
LANCASTER PA
17602-2374
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-4950
  • Fax:
Mailing address:
  • Phone: 717-544-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN592600
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: