Provider Demographics
NPI:1073915377
Name:BAUMAN, MELISSA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:FOTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:586 MOORSETOWN DR.
Mailing Address - Street 2:MOORESTOWN FAMILY PRACTICE
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-9713
Mailing Address - Country:US
Mailing Address - Phone:610-746-2010
Mailing Address - Fax:610-746-2060
Practice Address - Street 1:586 MOORSETOWN DR.
Practice Address - Street 2:MOORESTOWN FAMILY PRACTICE
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-9713
Practice Address - Country:US
Practice Address - Phone:610-746-2010
Practice Address - Fax:610-746-2060
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily