Provider Demographics
NPI:1093598740
Name:NORRIS, MELISSA KAY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:NORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 AMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-5700
Mailing Address - Country:US
Mailing Address - Phone:402-786-2765
Mailing Address - Fax:
Practice Address - Street 1:13401 AMBERLY RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-5700
Practice Address - Country:US
Practice Address - Phone:402-786-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant