Provider Demographics
NPI:1285852665
Name:BAHNEY, MELANIE JOLENE (LPN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOLENE
Last Name:BAHNEY
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 1:2257 W PEGGY DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242
Mailing Address - Country:US
Mailing Address - Phone:480-275-2306
Mailing Address - Fax:
Practice Address - Street 1:3101 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2419
Practice Address - Country:US
Practice Address - Phone:602-442-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTLP043152164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse