Individual
MICHAEL MELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1500 HIGHLANDS DR, LITITZ, PA 17543
(717) 782-3282
(717) 231-8964
Mailing address
409 S 2ND ST STE 2F, HARRISBURG, PA 17104-1612
(717) 782-3282
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN261026L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001746512
—
PA
Enumeration date
11/14/2005
Last updated
07/30/2019
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