Provider Demographics
NPI:1073907887
Name:CHURCHILL, MELINDA (RN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 N CENTRAL AVE
Mailing Address - Street 2:SUITE 901
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2204
Mailing Address - Country:US
Mailing Address - Phone:480-544-6714
Mailing Address - Fax:
Practice Address - Street 1:3443 N CENTRAL AVE
Practice Address - Street 2:SUITE 901
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2204
Practice Address - Country:US
Practice Address - Phone:480-544-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN177102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse