Provider Demographics
NPI:1962201475
Name:ABBOTT, MELISSA A
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:ABBOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 STATE ST
Mailing Address - Street 2:
Mailing Address - City:TABLE ROCK
Mailing Address - State:NE
Mailing Address - Zip Code:68447-3060
Mailing Address - Country:US
Mailing Address - Phone:402-914-0319
Mailing Address - Fax:
Practice Address - Street 1:410 STATE ST
Practice Address - Street 2:
Practice Address - City:TABLE ROCK
Practice Address - State:NE
Practice Address - Zip Code:68447-3060
Practice Address - Country:US
Practice Address - Phone:402-862-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home