Basic Information
| Provider Information | |||||||||
| NPI: | 1275606527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORELL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 WALTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149420380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 154 LAKEMONT PARK BLVD. | ||||||||
| Address2: | NFP | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166025900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149421903 | ||||||||
| FaxNumber: | 8145051100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN271147L | PA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1015943420001 | 05 | PA | MEDICAID |