Provider Demographics
NPI:1801384383
Name:VIGNOLA, MELANIE JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JEAN
Last Name:VIGNOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCCLELLAN AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4613
Mailing Address - Country:US
Mailing Address - Phone:856-361-1100
Mailing Address - Fax:
Practice Address - Street 1:2500 MCCLELLAN AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4613
Practice Address - Country:US
Practice Address - Phone:856-361-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08729200163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health