Provider Demographics
NPI:1346426871
Name:MELLOTT, GINA DIDAWICK (RN)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:DIDAWICK
Last Name:MELLOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:CAROLINE
Other - Last Name:DIDAWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:398 THEO HOVERMALE RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411
Mailing Address - Country:US
Mailing Address - Phone:304-258-1058
Mailing Address - Fax:
Practice Address - Street 1:247 HARRISON AVENUE
Practice Address - Street 2:MORGAN COUNTY BOARD OF EDUCATION
Practice Address - City:BERKELEY SPGS
Practice Address - State:WV
Practice Address - Zip Code:25411
Practice Address - Country:US
Practice Address - Phone:304-258-2430
Practice Address - Fax:304-258-4600
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse