Provider Demographics
NPI:1376154286
Name:UPHOLD, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:UPHOLD
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 1:320 N WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:BOBTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15315
Mailing Address - Country:US
Mailing Address - Phone:304-291-3345
Mailing Address - Fax:
Practice Address - Street 1:320 N WILLIS ST
Practice Address - Street 2:
Practice Address - City:BOBTOWN
Practice Address - State:PA
Practice Address - Zip Code:15315
Practice Address - Country:US
Practice Address - Phone:304-291-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant