Provider Demographics
NPI:1124232178
Name:BELLOVARY, MELISSA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:BELLOVARY
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:N3765 947TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK MOUND
Mailing Address - State:WI
Mailing Address - Zip Code:54739-4500
Mailing Address - Country:US
Mailing Address - Phone:715-874-4482
Mailing Address - Fax:
Practice Address - Street 1:N3765 947TH ST
Practice Address - Street 2:
Practice Address - City:ELK MOUND
Practice Address - State:WI
Practice Address - Zip Code:54739-4500
Practice Address - Country:US
Practice Address - Phone:715-874-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303455-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse