Provider Demographics
NPI:1003422411
Name:WOODSON, MELISSA JOY (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOY
Last Name:WOODSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JOY
Other - Last Name:LANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:GERING PUBLIC SCHOOL DISTRICT
Mailing Address - Street 2:519 10TH ST
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341
Mailing Address - Country:US
Mailing Address - Phone:308-463-3123
Mailing Address - Fax:308-436-6010
Practice Address - Street 1:GERING JUNIOR HIGH SCHOOL
Practice Address - Street 2:800 Q STREET
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-436-3123
Practice Address - Fax:308-436-6010
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE85911163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-6005311Medicaid