Provider Demographics
NPI:1265801955
Name:BAER, MELISSA MAY (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:MAY
Last Name:BAER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N. CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533
Mailing Address - Country:US
Mailing Address - Phone:484-650-2058
Mailing Address - Fax:
Practice Address - Street 1:115 N CENTRE AVE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8819
Practice Address - Country:US
Practice Address - Phone:484-650-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281966164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse