Provider Demographics
NPI:1487162772
Name:MELLENTINE, CARLI (BIRTH DOULA)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:MELLENTINE
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 N BAYLAND DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9245
Mailing Address - Country:US
Mailing Address - Phone:317-589-0711
Mailing Address - Fax:
Practice Address - Street 1:9239 N BAYLAND DR
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9245
Practice Address - Country:US
Practice Address - Phone:317-589-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula