Provider Demographics
NPI:1669986725
Name:STANISCH, MELINDA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:STANISCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:GAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 JOHNSONBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3488
Mailing Address - Country:US
Mailing Address - Phone:814-788-8580
Mailing Address - Fax:
Practice Address - Street 1:757 JOHNSONBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3488
Practice Address - Country:US
Practice Address - Phone:814-788-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP018165OtherSTATE LICENSE