Provider Demographics
NPI:1255330494
Name:MELLIN, NANCY R (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:MELLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-3668
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:42401 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2405
Practice Address - Country:US
Practice Address - Phone:985-542-9155
Practice Address - Fax:985-542-9133
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020570207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1922391Medicaid
LAF13288Medicare UPIN
LA1922391Medicaid
LA5N828CQ96Medicare PIN
LAP00308095Medicare PIN