Provider Demographics
NPI:1235831892
Name:TOMPKINS, MELODIE J (RN)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:J
Last Name:TOMPKINS
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 1:489 MUTTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEVERSINK
Mailing Address - State:NY
Mailing Address - Zip Code:12765-5027
Mailing Address - Country:US
Mailing Address - Phone:845-796-8579
Mailing Address - Fax:
Practice Address - Street 1:489 MUTTON HILL RD
Practice Address - Street 2:
Practice Address - City:NEVERSINK
Practice Address - State:NY
Practice Address - Zip Code:12765-5027
Practice Address - Country:US
Practice Address - Phone:845-796-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY465225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse