Provider Demographics
NPI:1992940506
Name:LEAL, MELISSA J (LPN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:LEAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 TOWNSHIP ROAD 14
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:OH
Mailing Address - Zip Code:45889-9608
Mailing Address - Country:US
Mailing Address - Phone:419-722-0826
Mailing Address - Fax:
Practice Address - Street 1:1029 TOWNSHIP ROAD 14
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:OH
Practice Address - Zip Code:45889-9608
Practice Address - Country:US
Practice Address - Phone:419-722-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 132039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse