Provider Demographics
NPI:1275606527
Name:HORELL, MELISSA A (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:HORELL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-942-0380
Mailing Address - Fax:
Practice Address - Street 1:154 LAKEMONT PARK BLVD.
Practice Address - Street 2:NFP
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5900
Practice Address - Country:US
Practice Address - Phone:814-942-1903
Practice Address - Fax:814-505-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN271147L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015943420001Medicaid
PA1015943420001Medicaid