Provider Demographics
NPI:1497896989
Name:ROSENAU, MELISSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:ROSENAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1575
Mailing Address - Country:US
Mailing Address - Phone:215-257-3700
Mailing Address - Fax:
Practice Address - Street 1:711 LAWN AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1575
Practice Address - Country:US
Practice Address - Phone:215-257-3700
Practice Address - Fax:215-257-0360
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant