Provider Demographics
NPI:1740142090
Name:CERNIC-KATES, MELISA MARIE
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:MARIE
Last Name:CERNIC-KATES
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 1:1020 N QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3810
Mailing Address - Country:US
Mailing Address - Phone:641-683-4300
Mailing Address - Fax:641-683-4302
Practice Address - Street 1:1020 N QUINCY AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3810
Practice Address - Country:US
Practice Address - Phone:641-683-4300
Practice Address - Fax:641-683-4302
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse