Provider Demographics
NPI:1194078725
Name:GOLDSBERRY, MELISSA K (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:GOLDSBERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9167 STATE ROUTE 505
Mailing Address - Street 2:
Mailing Address - City:HAMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45130-8423
Mailing Address - Country:US
Mailing Address - Phone:812-216-9844
Mailing Address - Fax:
Practice Address - Street 1:9167 STATE ROUTE 505
Practice Address - Street 2:
Practice Address - City:HAMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45130-8423
Practice Address - Country:US
Practice Address - Phone:812-216-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110747164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110747OtherOHIO BOARD OF NURSING