Organization
ACTION WELLNESS NP IN FAMILY HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA CLARKE NP (OWNER/SOLE MEMBER)
(631) 500-0388
Entity
Organization
Contact information
Practice address
116 N HURON ST, RONKONKOMA, NY 11779-3532
(631) 500-0388
Mailing address
116 N HURON ST, RONKONKOMA, NY 11779-3532
(631) 500-0388
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184999344
NPPES - NPI NUMBER
—
01
—
344753
NURSE PRACTITIONER LICENSE
NY
01
—
405889
NYSED BOARD OF NURSING
NY
Enumeration date
12/07/2021
Last updated
05/23/2024
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