Provider Demographics
NPI:1497213896
Name:MARTIN, MELISSA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COUNTY SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4338
Mailing Address - Country:US
Mailing Address - Phone:931-528-2531
Mailing Address - Fax:931-526-7451
Practice Address - Street 1:701 COUNTY SERVICES DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4338
Practice Address - Country:US
Practice Address - Phone:931-528-2531
Practice Address - Fax:931-526-7451
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65413164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse