Provider Demographics
NPI:1225271620
Name:MELVIN, JENNIFER LYNN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 MOSSY BANK DR
Mailing Address - Street 2:APT #3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2352
Mailing Address - Country:US
Mailing Address - Phone:916-646-6645
Mailing Address - Fax:
Practice Address - Street 1:2340 MOSSY BANK DR
Practice Address - Street 2:APT #3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-2352
Practice Address - Country:US
Practice Address - Phone:916-646-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN176267164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse