Provider Demographics
NPI:1407441728
Name:REVELLO, MELISSA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:REVELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:HETRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 SHAELI DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1805
Mailing Address - Country:US
Mailing Address - Phone:814-443-0130
Mailing Address - Fax:
Practice Address - Street 1:104 BYERS RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7752
Practice Address - Country:US
Practice Address - Phone:814-233-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN622491163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology