Provider Demographics
NPI:1821284977
Name:RICKARD, MELISSA LEE (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:RICKARD
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:601 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1459
Mailing Address - Country:US
Mailing Address - Phone:570-251-6641
Mailing Address - Fax:570-253-8228
Practice Address - Street 1:600 MAPLE AVE SUITE 2
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1459
Practice Address - Country:US
Practice Address - Phone:570-251-6672
Practice Address - Fax:570-251-6668
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2016-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAVP007039B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057231JJMMedicare Oscar/Certification