Provider Demographics
NPI:1366622524
Name:MERICLE, MELISSA JEAN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:MERICLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:MERICLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6272 E 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9229
Mailing Address - Country:US
Mailing Address - Phone:303-451-5156
Mailing Address - Fax:
Practice Address - Street 1:6272 E 135TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9229
Practice Address - Country:US
Practice Address - Phone:303-451-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109956163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory