Provider Demographics
NPI:1154710713
Name:LAUNDER, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LAUNDER
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:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LANDERS
Mailing Address - State:CA
Mailing Address - Zip Code:92285-0290
Mailing Address - Country:US
Mailing Address - Phone:760-660-9438
Mailing Address - Fax:
Practice Address - Street 1:58821 MITCH LN
Practice Address - Street 2:
Practice Address - City:LANDERS
Practice Address - State:CA
Practice Address - Zip Code:92285
Practice Address - Country:US
Practice Address - Phone:760-660-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47-2813203OtherEIN