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Individual

MRS. MELANIE RENAE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
761 JOHNSONBURG RD, SUITE #160, SAINT MARYS, PA 15857-3483
(814) 788-8777
(814) 788-8770
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-4200
(814) 375-4232

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
OA003330
PA
363AM0700X
Medical Physician Assistant
Primary
MA056954
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
103146235
PA
Enumeration date
09/16/2014
Last updated
10/23/2020
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