Provider Demographics
NPI:1326691288
Name:DANIELS, MELINDA LEA (LPN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEA
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19901 INLET RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-5105
Mailing Address - Country:US
Mailing Address - Phone:573-378-9775
Mailing Address - Fax:
Practice Address - Street 1:104 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1346
Practice Address - Country:US
Practice Address - Phone:573-378-5438
Practice Address - Fax:573-378-7375
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007311164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse