Provider Demographics
NPI:1528252442
Name:STEPHENSON, MELINDA RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:RENEE
Last Name:STEPHENSON
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 1:502 LIGHTWIND CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5077
Mailing Address - Country:US
Mailing Address - Phone:614-987-6003
Mailing Address - Fax:
Practice Address - Street 1:502 LIGHTWIND CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5077
Practice Address - Country:US
Practice Address - Phone:614-987-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN082870164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse