Provider Demographics
NPI:1003062670
Name:MELLINGTON, TERESA E (ACNP-BC, AOCNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:MELLINGTON
Suffix:
Gender:F
Credentials:ACNP-BC, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 BELMONT AVENUE
Mailing Address - Street 2:MERCY HEALTH
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-1096
Mailing Address - Country:US
Mailing Address - Phone:330-480-8015
Mailing Address - Fax:330-480-4398
Practice Address - Street 1:1044 BELMONT AVENUE
Practice Address - Street 2:MERCY HEALTH ONCOLOGY
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501-1096
Practice Address - Country:US
Practice Address - Phone:330-480-8015
Practice Address - Fax:330-480-4398
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10168NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2924143Medicaid
OHH125570OtherMEDICARE PTAN