Provider Demographics
NPI:1467737973
Name:DORN, MELISSA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:DORN
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:W1279 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9592
Mailing Address - Country:US
Mailing Address - Phone:715-218-2407
Mailing Address - Fax:
Practice Address - Street 1:W1279 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-9592
Practice Address - Country:US
Practice Address - Phone:715-218-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194234-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse