Provider Demographics
NPI:1407685167
Name:WAESCH, MELINDA JEAN
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:JEAN
Last Name:WAESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6543 DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8672
Mailing Address - Country:US
Mailing Address - Phone:937-492-0704
Mailing Address - Fax:
Practice Address - Street 1:6543 DAWSON RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8672
Practice Address - Country:US
Practice Address - Phone:937-492-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105076164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse