Healthcare Provider Details

I. General information

NPI: 1518589464
Provider Name (Legal Business Name): MELANIE JOYCE KUKICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 FORWARD AVE
PITTSBURGH PA
15217-2255
US

IV. Provider business mailing address

5725 FORWARD AVE
PITTSBURGH PA
15217-2255
US

V. Phone/Fax

Practice location:
  • Phone: 412-214-0042
  • Fax:
Mailing address:
  • Phone: 412-214-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN714075
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP026896
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: