Provider Demographics
NPI:1487919940
Name:VANDYNE, MECHELLE DAWN (LPN)
Entity type:Individual
Prefix:
First Name:MECHELLE
Middle Name:DAWN
Last Name:VANDYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51577 HEADLEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716-9543
Mailing Address - Country:US
Mailing Address - Phone:740-213-3664
Mailing Address - Fax:
Practice Address - Street 1:51577 HEADLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43716-9543
Practice Address - Country:US
Practice Address - Phone:740-213-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.097181-MEDS164W00000X
WV23036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse