Provider Demographics
NPI:1467770339
Name:HLADEK, MELISSA DECARDI (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DECARDI
Last Name:HLADEK
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 1:1660 COLUMBIA RD NW
Mailing Address - Street 2:COLUMBIA ROAD HEALTH SERVICES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3602
Mailing Address - Country:US
Mailing Address - Phone:202-328-3717
Mailing Address - Fax:202-319-6946
Practice Address - Street 1:1660 COLUMBIA RD NW
Practice Address - Street 2:COLUMBIA ROAD HEALTH SERVICES
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3602
Practice Address - Country:US
Practice Address - Phone:202-328-3717
Practice Address - Fax:202-319-6946
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1016852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024905300Medicaid