Provider Demographics
NPI:1164968475
Name:HUNTLEY, MELANIE (CRNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N NEGLEY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-2431
Mailing Address - Country:US
Mailing Address - Phone:412-404-4000
Mailing Address - Fax:
Practice Address - Street 1:117 N NEGLEY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3518
Practice Address - Country:US
Practice Address - Phone:412-404-4000
Practice Address - Fax:412-404-4004
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033221630001Medicaid