Provider Demographics
NPI:1275170474
Name:BREWER, MELINA CHARRELL (CRNP)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:CHARRELL
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:225 N FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2240
Practice Address - Country:US
Practice Address - Phone:717-939-4593
Practice Address - Fax:717-939-0955
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN661708163W00000X
PASP021251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA942325OtherMEDICARE
PA1037434230001Medicaid