Provider Demographics
NPI:1497078398
Name:FLANNERY, MELONY JANE (RN)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:JANE
Last Name:FLANNERY
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 1:650 WOLF RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PELICAN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54463-9703
Mailing Address - Country:US
Mailing Address - Phone:715-275-3125
Mailing Address - Fax:
Practice Address - Street 1:650 WOLF RIVER RD
Practice Address - Street 2:
Practice Address - City:PELICAN LAKE
Practice Address - State:WI
Practice Address - Zip Code:54463-9703
Practice Address - Country:US
Practice Address - Phone:715-275-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI79541-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse