Provider Demographics
NPI:1942923099
Name:MCCONNELL, MELISSA SUE (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 FALL RUN RD
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-7812
Mailing Address - Country:US
Mailing Address - Phone:570-423-9957
Mailing Address - Fax:
Practice Address - Street 1:160 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1499
Practice Address - Country:US
Practice Address - Phone:570-215-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily