Provider Demographics
NPI:1871774950
Name:SMITH, MELANIE J
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:J
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 PARK RD
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2420
Mailing Address - Country:US
Mailing Address - Phone:907-304-4005
Mailing Address - Fax:
Practice Address - Street 1:2580 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1294
Practice Address - Country:US
Practice Address - Phone:724-770-7999
Practice Address - Fax:724-843-1514
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26822163W00000X
OH321791163W00000X
PASP019163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty