Provider Demographics
NPI:1659122851
Name:REVENS, MELISSA BRIGETTE (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BRIGETTE
Last Name:REVENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 10TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2419
Mailing Address - Country:US
Mailing Address - Phone:267-244-2306
Mailing Address - Fax:
Practice Address - Street 1:100 N 10TH ST STE 7
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2419
Practice Address - Country:US
Practice Address - Phone:267-244-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN289023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse