Provider Demographics
NPI:1053427062
Name:MELVILLE, MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-909-4670
Mailing Address - Fax:717-909-4675
Practice Address - Street 1:3720 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4325
Practice Address - Country:US
Practice Address - Phone:717-909-4670
Practice Address - Fax:717-909-4675
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005569D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342537Medicaid
PA4174183OtherCIGNA
PA102279980Medicaid
P86813Medicare UPIN
NH30342537Medicaid
PA552711Medicare PIN