Provider Demographics
NPI:1467614271
Name:STENZ, MELISSA LEA (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LEA
Last Name:STENZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LEA
Other - Last Name:HURLBUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4049
Mailing Address - Country:US
Mailing Address - Phone:315-216-6818
Mailing Address - Fax:
Practice Address - Street 1:453 PARK ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2523
Practice Address - Country:US
Practice Address - Phone:315-592-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284826-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse