Provider Demographics
NPI:1669411393
Name:CALLAHAN, MELISSA A (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:HENOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:320 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2450
Mailing Address - Country:US
Mailing Address - Phone:866-268-6609
Mailing Address - Fax:866-610-4542
Practice Address - Street 1:320 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2450
Practice Address - Country:US
Practice Address - Phone:866-268-6609
Practice Address - Fax:866-610-4542
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006181H363LG0600X
PATP006182C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102510472 0001OtherPROMISE NUMBER
PA032688YCCWOtherMEDICARE NUMBER
PA102510472 0001OtherPROMISE NUMBER
PAS91916Medicare UPIN