Provider Demographics
NPI:1154562627
Name:HUTTON, MELINDA L
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:HUTTON
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 1:2062 N. LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460
Mailing Address - Country:US
Mailing Address - Phone:330-831-7778
Mailing Address - Fax:
Practice Address - Street 1:2062 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9312
Practice Address - Country:US
Practice Address - Phone:330-831-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372600000X, 3747P1801X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide