Healthcare Provider Details

I. General information

NPI: 1639980295
Provider Name (Legal Business Name): LYNDSEY RENEE MELLON BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRFIELD DR
SENECA PA
16346-2130
US

IV. Provider business mailing address

840 WOOD ST
CLARION PA
16214-1240
US

V. Phone/Fax

Practice location:
  • Phone: 814-676-7845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN734511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: