Provider Demographics
NPI:1891503397
Name:RODRIGUEZ, MELISSA RAE (L P N)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:L P N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1973
Mailing Address - Country:US
Mailing Address - Phone:717-639-9023
Mailing Address - Fax:
Practice Address - Street 1:1427 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-1973
Practice Address - Country:US
Practice Address - Phone:717-639-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse