Provider Demographics
NPI:1366601239
Name:KALNENIEKS, MELONIE C (PA-C)
Entity type:Individual
Prefix:
First Name:MELONIE
Middle Name:C
Last Name:KALNENIEKS
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 1:1049 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2114
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-304-4672
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2107
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-304-4672
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMC0669789JOtherCONTROLLED SUBSTANCE REGISTRATION
MA1310097Medicaid
MAMC1577177OtherDEA
MAMC1577177OtherDEA