Provider Demographics
NPI:1316094048
Name:MELENDEZ, LAURELYNNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAURELYNNE
Middle Name:
Last Name:MELENDEZ
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 1:288 LISBON RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9485
Mailing Address - Country:US
Mailing Address - Phone:330-427-2860
Mailing Address - Fax:
Practice Address - Street 1:478 CHESTNUT STREET EXT
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-9703
Practice Address - Country:US
Practice Address - Phone:330-427-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 105929164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2276568OtherHOME HEALTH PROVIDER