Healthcare Provider Details

I. General information

NPI: 1639417850
Provider Name (Legal Business Name): MELISSA HORTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN RENFER

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 HUNTINGDON PIKE
MEADOWBROOK PA
19046-8001
US

IV. Provider business mailing address

1648 HUNTINGDON PIKE MEDICAL STAFF OFFICE FIRST FLOOR
MEADOWBROOK PA
19046-8001
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-4000
  • Fax:
Mailing address:
  • Phone: 215-938-3450
  • Fax: 215-938-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012739
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN267248L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: