Provider Demographics
NPI:1346542404
Name:KOWLESSAR, MELISSA JUNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JUNE
Last Name:KOWLESSAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JUNE
Other - Last Name:SKIPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:69 BENSON STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206
Mailing Address - Country:US
Mailing Address - Phone:518-788-5770
Mailing Address - Fax:
Practice Address - Street 1:69 BENSON STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206
Practice Address - Country:US
Practice Address - Phone:518-788-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267463164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse