Provider Demographics
NPI:1043590201
Name:BRICE, MELLIE (LPN)
Entity Type:Individual
Prefix:
First Name:MELLIE
Middle Name:
Last Name:BRICE
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 1:115 LENOX RD
Mailing Address - Street 2:APT-F5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2482
Mailing Address - Country:US
Mailing Address - Phone:646-402-1158
Mailing Address - Fax:
Practice Address - Street 1:115 LENOX RD
Practice Address - Street 2:APT-F5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2482
Practice Address - Country:US
Practice Address - Phone:646-402-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304628164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse