Provider Demographics
NPI:1114446770
Name:WEBSTER, MELISSA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:WEBSTER
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 1:202 ARLINGTON AVE. SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1137
Mailing Address - Country:US
Mailing Address - Phone:330-371-0934
Mailing Address - Fax:234-714-9317
Practice Address - Street 1:202 ARLINGTON AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1137
Practice Address - Country:US
Practice Address - Phone:330-371-0934
Practice Address - Fax:234-714-9317
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN219514163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice