Provider Demographics
NPI:1740799139
Name:CULBERTSON, MELINDA (FNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3522
Mailing Address - Country:US
Mailing Address - Phone:330-238-4455
Mailing Address - Fax:
Practice Address - Street 1:1939 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3522
Practice Address - Country:US
Practice Address - Phone:330-238-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00020366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLE-00020366OtherAPRN
OHRN.418313OtherRN