Provider Demographics
NPI:1326741331
Name:GARRETT, MELINDA JOANN
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JOANN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 N BRIARWOOD LN STE 1
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6374
Mailing Address - Country:US
Mailing Address - Phone:463-777-5770
Mailing Address - Fax:765-288-6520
Practice Address - Street 1:3640 N BRIARWOOD LN STE 1
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6374
Practice Address - Country:US
Practice Address - Phone:463-777-5770
Practice Address - Fax:765-288-6520
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27056414A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse