Provider Demographics
NPI:1275719007
Name:MELNICK, JENNIFER P (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:MELNICK
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 1:110 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1120
Mailing Address - Country:US
Mailing Address - Phone:315-894-8839
Mailing Address - Fax:
Practice Address - Street 1:110 W RIVER ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1120
Practice Address - Country:US
Practice Address - Phone:315-894-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584911163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience