Provider Demographics
NPI:1346865748
Name:SPOON, MELANIE D
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:SPOON
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 1:777 PR 1183
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446
Mailing Address - Country:US
Mailing Address - Phone:254-413-3537
Mailing Address - Fax:
Practice Address - Street 1:777 PR 1183
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446
Practice Address - Country:US
Practice Address - Phone:254-413-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse