Provider Demographics
NPI:1285235671
Name:NELSON, MELONY DAWN
Entity type:Individual
Prefix:
First Name:MELONY
Middle Name:DAWN
Last Name:NELSON
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 1:1665 HAPPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320-5714
Mailing Address - Country:US
Mailing Address - Phone:304-415-3596
Mailing Address - Fax:
Practice Address - Street 1:1 DUNBAR PLZ STE 200
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3038
Practice Address - Country:US
Practice Address - Phone:304-342-5839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant