Provider Demographics
NPI:1972758464
Name:TOMON, MELISSA MICHELLE (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:TOMON
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MICHELLE
Other - Last Name:DELLA PORTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:100 E LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1012
Mailing Address - Country:US
Mailing Address - Phone:215-707-1060
Mailing Address - Fax:215-707-1050
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-1060
Practice Address - Fax:215-707-1050
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner