Provider Demographics
NPI:1336940063
Name:STORM, MELODY ANN
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:STORM
Suffix:
Gender:
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 174
Mailing Address - Street 2:
Mailing Address - City:COLERIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:68727-0174
Mailing Address - Country:US
Mailing Address - Phone:402-841-7808
Mailing Address - Fax:
Practice Address - Street 1:204 N ABERLEY AVE
Practice Address - Street 2:
Practice Address - City:HARTINGTON
Practice Address - State:NE
Practice Address - Zip Code:68739-5117
Practice Address - Country:US
Practice Address - Phone:402-841-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide