Provider Demographics
NPI:1922061100
Name:MOHLER, MELANIE M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:M
Last Name:MOHLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:M
Other - Last Name:LEININGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:484-526-3990
Mailing Address - Fax:610-868-2915
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 603
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-3990
Practice Address - Fax:610-868-2915
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004597P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101225948Medicaid
PA1012259480001Medicaid
PA036901Medicare ID - Type Unspecified
PA101225948Medicaid
PA1012259480001Medicaid
PA261345R04Medicare PIN