Provider Demographics
NPI:1225814619
Name:HERN, MELISSA LEE (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:HERN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9278
Mailing Address - Country:US
Mailing Address - Phone:607-256-5033
Mailing Address - Fax:
Practice Address - Street 1:161 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-9278
Practice Address - Country:US
Practice Address - Phone:607-256-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN716355163W00000X
NY592825-1163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163W00000XNursing Service ProvidersRegistered Nurse