=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871259382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE JANE MARZULLO PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2021
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HOSPITAL RD
-----------------------------------------------------
City | BROOKVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15825-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-849-1850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 SHAFFER RD
-----------------------------------------------------
City | SIGEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15860-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-603-1413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | SP024602
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP024602
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------