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1053932749
LARRY DEAN MELLOTT
EPHRATA, PA
NPI
1053932749
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: PA RN645912)
Enumeration Date
2020-05-04
Last Update Date
2020-05-04
Business Address
LARRY DEAN MELLOTT CRNA
169 MARTIN AVE
EPHRATA, PA 17522-1724
Phone number: 717-738-6618
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Mailing Address
LARRY DEAN MELLOTT CRNA
3421 CONCORD RD
YORK, PA 17402-9001
Phone number: 717-851-1405
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