Provider Demographics
NPI:1477297729
Name:GESSEL, MELYNDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:
Last Name:GESSEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MELYNDA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 N 3737 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5738
Mailing Address - Country:US
Mailing Address - Phone:208-346-3612
Mailing Address - Fax:
Practice Address - Street 1:12 N 3737 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5738
Practice Address - Country:US
Practice Address - Phone:208-346-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID23854163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty