Provider Demographics
NPI:1073345005
Name:MELTON, DIANE R
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:MELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 IBIS WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8739
Mailing Address - Country:US
Mailing Address - Phone:252-506-1207
Mailing Address - Fax:
Practice Address - Street 1:202 N MCMORRINE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4474
Practice Address - Country:US
Practice Address - Phone:252-506-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach