Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP024243 | PA |
NPI | 1093488777 |
---|---|
Provider Name | Melissa Joanne Dennis |
First Address | Harrisburg, PA 17101-2542 |
Second Address | Harrisburg, PA 17101-2542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 11/10/2021 |