Basic Information
| Provider Information | |||||||||
| NPI: | 1942778592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HETZELL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MSN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 CL# 4480 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191954480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738737000 | ||||||||
| FaxNumber: | 9738737035 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 W SPRING VALLEY AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | MAYWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076071444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014878866 | ||||||||
| FaxNumber: | 2014872602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2018 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR14503200 | NJ | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 26NJ00871400 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2100X | 26NJ00871400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.