Healthcare Provider Details

I. General information

NPI: 1750375085
Provider Name (Legal Business Name): DEBORAH MELLON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E MARSHALL ST
WEST CHESTER PA
19380-4412
US

IV. Provider business mailing address

5 STONEHEDGE DR
GLENMOORE PA
19343-8901
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-5594
  • Fax: 431-431-5157
Mailing address:
  • Phone: 610-458-5378
  • Fax: 610-431-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberVP003302G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: