Provider Demographics
NPI:1023168317
Name:ULM, MELANIE SCHMUCKER (CRNA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:SCHMUCKER
Last Name:ULM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SCHMUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:51 NORTH 39TH STREET
Mailing Address - Street 2:223 WRIGHT/SAUNDERS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8244
Mailing Address - Fax:
Practice Address - Street 1:2690 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9100
Practice Address - Country:US
Practice Address - Phone:843-572-1228
Practice Address - Fax:843-576-6168
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN601626367500000X
OH277207367500000X
SC18487367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1972OtherYEAR OF BIRTH
OH1972OtherYEAR OF BIRTH