Provider Demographics
NPI:1992985527
Name:WEST, MELANIE L (LPN)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:RENNINGER
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1869 OLD BERWICK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3033
Mailing Address - Country:US
Mailing Address - Phone:570-784-3059
Mailing Address - Fax:570-784-5228
Practice Address - Street 1:1869 OLD BERWICK RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3033
Practice Address - Country:US
Practice Address - Phone:570-784-3059
Practice Address - Fax:570-784-5228
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104477L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse