Provider Demographics
NPI:1437471422
Name:CRAFT, MELISSA K (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7035
Mailing Address - Country:US
Mailing Address - Phone:937-738-7310
Mailing Address - Fax:
Practice Address - Street 1:510 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7035
Practice Address - Country:US
Practice Address - Phone:937-738-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN137862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse