Provider Demographics
NPI:1235226119
Name:VALLIERE, MELENNA JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:MELENNA
Middle Name:JANE
Last Name:VALLIERE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MELENNA
Other - Middle Name:JANE
Other - Last Name:CROMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:CMR 416
Mailing Address - Street 2:BOX 280
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09140
Mailing Address - Country:US
Mailing Address - Phone:01-149-9841
Mailing Address - Fax:834834
Practice Address - Street 1:USAMEDDAC WUERZBURG
Practice Address - Street 2:ILLESHEIM CLINIC
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09140
Practice Address - Country:DE
Practice Address - Phone:01-149-9841
Practice Address - Fax:834834
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN 084394261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center