Provider Demographics
NPI:1477104149
Name:GOLER, MELISSA ROSE-ANN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE-ANN
Last Name:GOLER
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 1:1027 ONEIDA TRL SW
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9417
Mailing Address - Country:US
Mailing Address - Phone:330-280-7738
Mailing Address - Fax:
Practice Address - Street 1:1027 ONEIDA TRL SW
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9417
Practice Address - Country:US
Practice Address - Phone:330-280-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2020-02-18
Deactivation Date:2019-11-25
Deactivation Code:
Reactivation Date:2020-02-13
Provider Licenses
StateLicense IDTaxonomies
OHRN378560163W00000X
OHRN.378560101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse