Provider Demographics
NPI:1043529332
Name:MELBY, LYNETTE (CNP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:MELBY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 PARK LN
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3132
Mailing Address - Country:US
Mailing Address - Phone:605-677-7493
Mailing Address - Fax:605-624-6814
Practice Address - Street 1:437 PARK LN
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3132
Practice Address - Country:US
Practice Address - Phone:605-677-7493
Practice Address - Fax:605-624-6814
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6833540Medicaid