Individual
MRS. MELISSA MARIE PRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
120 S TAN STREET, SUITE 1, FREDERICKSBURG, PA 17026-0009
(717) 865-6644
Mailing address
409 S 2ND ST STE 2F, HARRISBURG, PA 17104-1612
(717) 865-6644
(717) 865-5666
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA057661
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103181548
—
PA
Enumeration date
07/13/2015
Last updated
01/29/2021
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