Provider Demographics
NPI:1982715413
Name:VANHOOK, MELONY K
Entity type:Individual
Prefix:MRS
First Name:MELONY
Middle Name:K
Last Name:VANHOOK
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 1:727 NAVCO DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4718
Mailing Address - Country:US
Mailing Address - Phone:765-446-0615
Mailing Address - Fax:765-446-0616
Practice Address - Street 1:727 NAVCO DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4718
Practice Address - Country:US
Practice Address - Phone:765-446-0615
Practice Address - Fax:765-446-0616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5434430001Medicare ID - Type Unspecified