Provider Demographics
NPI:1417082496
Name:DARDIS, MELISSA RUTH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RUTH
Last Name:DARDIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 S KYRENE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2108
Mailing Address - Country:US
Mailing Address - Phone:480-783-4043
Mailing Address - Fax:480-783-4051
Practice Address - Street 1:8700 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2108
Practice Address - Country:US
Practice Address - Phone:480-783-4043
Practice Address - Fax:480-783-4051
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN073089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse