Provider Demographics
NPI:1467908194
Name:LUNDBERG, MELISSA PATERAKIS (RN MSN CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:PATERAKIS
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:RN MSN CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:PATERAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1400 LANCASTER ST
Mailing Address - Street 2:UNIT 1003
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3349
Mailing Address - Country:US
Mailing Address - Phone:443-474-6846
Mailing Address - Fax:
Practice Address - Street 1:1000 HILLTOP CIRCLE ERICKSON HALL GROUND FLOOR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250
Practice Address - Country:US
Practice Address - Phone:410-455-2542
Practice Address - Fax:410-455-1125
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily