Provider Demographics
NPI:1487957833
Name:MINER, MELISSA CAROLYNE (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROLYNE
Last Name:MINER
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 1:1213 OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9588
Mailing Address - Country:US
Mailing Address - Phone:937-572-4172
Mailing Address - Fax:
Practice Address - Street 1:1213 OGDEN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9588
Practice Address - Country:US
Practice Address - Phone:937-572-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse