Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP017098 | PA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP017098 | PA |
NPI | 1518407832 |
---|---|
Provider Name | Melissa Ann Cargan-Bodnar |
First Address | West Chester, PA 19380-4412 |
Second Address | West Chester, PA 19380-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 23/04/2018 |