Provider Demographics
NPI:1932487808
Name:PISTENTIS, MELANIE IRENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:IRENE
Last Name:PISTENTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:911 LIGONIER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-539-9736
Mailing Address - Fax:724-539-2836
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-539-9736
Practice Address - Fax:724-539-2836
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical