Healthcare Provider Details

I. General information

NPI: 1114787306
Provider Name (Legal Business Name): MELODY A MILLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WELLNOW URGENT CARE 917 S ST MARYS ST
ST MARYS PA
15857
US

IV. Provider business mailing address

53 WALTER RD
GRAMPIAN PA
16838-8945
US

V. Phone/Fax

Practice location:
  • Phone: 814-389-1026
  • Fax:
Mailing address:
  • Phone: 814-771-3352
  • Fax: 814-583-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029407
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: