Healthcare Provider Details

I. General information

NPI: 1568021830
Provider Name (Legal Business Name): MELINDA WENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 LAFAYETTE AVE
PALMERTON PA
18071-1518
US

IV. Provider business mailing address

ST. LUKE'S CVO 801 OSTRUM ST.
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: