Provider Demographics
NPI:1386156990
Name:BUSSE, MELONIE G (LPN)
Entity type:Individual
Prefix:
First Name:MELONIE
Middle Name:G
Last Name:BUSSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MELONIE
Other - Middle Name:G
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:41 S CRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1051 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1110
Practice Address - Country:US
Practice Address - Phone:330-935-2663
Practice Address - Fax:330-793-7666
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN150222164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse