Provider Demographics
NPI:1467185975
Name:MELVIN, MAKAYLA E
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:E
Last Name:MELVIN
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 1:34446 BALD EAGLE TRL
Mailing Address - Street 2:
Mailing Address - City:FRAZEE
Mailing Address - State:MN
Mailing Address - Zip Code:56544-8957
Mailing Address - Country:US
Mailing Address - Phone:218-849-2375
Mailing Address - Fax:
Practice Address - Street 1:34446 BALD EAGLE TRL
Practice Address - Street 2:
Practice Address - City:FRAZEE
Practice Address - State:MN
Practice Address - Zip Code:56544-8957
Practice Address - Country:US
Practice Address - Phone:218-849-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program