Provider Demographics
NPI:1841593274
Name:ROENNPAGEL, MELISSA RAE (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:ROENNPAGEL
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 1:165 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-3222
Mailing Address - Country:US
Mailing Address - Phone:518-895-8310
Mailing Address - Fax:518-895-2957
Practice Address - Street 1:165 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-3222
Practice Address - Country:US
Practice Address - Phone:518-895-8310
Practice Address - Fax:518-895-2957
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 423486163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool