Provider Demographics
NPI:1942778592
Name:HETZELL, MELISSA C (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:HETZELL
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000 CL# 4480
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4480
Mailing Address - Country:US
Mailing Address - Phone:973-873-7000
Mailing Address - Fax:973-873-7035
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:201-487-8866
Practice Address - Fax:201-487-2602
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14503200163W00000X
NJ26NJ00871400363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily