Provider Demographics
NPI:1174957781
Name:BRUBAKER, MELISSA (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 COMMERCE DR # 301
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2600
Mailing Address - Country:US
Mailing Address - Phone:484-759-8611
Mailing Address - Fax:445-201-3851
Practice Address - Street 1:390 COMMERCE DR # 301
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2600
Practice Address - Country:US
Practice Address - Phone:484-759-8611
Practice Address - Fax:445-201-3851
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020670363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health