Provider Demographics
NPI:1124321211
Name:MELOCCARO, STEVEN (CNA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MELOCCARO
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 S 90TH ST
Mailing Address - Street 2:15
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2474
Mailing Address - Country:US
Mailing Address - Phone:712-326-8834
Mailing Address - Fax:
Practice Address - Street 1:9105 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4723
Practice Address - Country:US
Practice Address - Phone:402-502-8330
Practice Address - Fax:402-502-8331
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25855376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide