Provider Demographics
NPI:1992520811
Name:DAVIS, MELANIE DIANE (RN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34784 HUSTON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:OH
Mailing Address - Zip Code:45695-8946
Mailing Address - Country:US
Mailing Address - Phone:740-517-4806
Mailing Address - Fax:
Practice Address - Street 1:34784 HUSTON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:OH
Practice Address - Zip Code:45695-8946
Practice Address - Country:US
Practice Address - Phone:740-517-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN277404163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation