Provider Demographics
NPI:1073136032
Name:LOCASCIO, MELISSA CORTNIE (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CORTNIE
Last Name:LOCASCIO
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 1:2786 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1203
Mailing Address - Country:US
Mailing Address - Phone:856-308-3814
Mailing Address - Fax:
Practice Address - Street 1:2786 N 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1203
Practice Address - Country:US
Practice Address - Phone:856-308-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322427-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse