Provider Demographics
NPI:1497379382
Name:PAHUYO, MELANIE (RN-BSN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PAHUYO
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19855 STAMPER LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3326
Mailing Address - Country:US
Mailing Address - Phone:706-300-4164
Mailing Address - Fax:
Practice Address - Street 1:19855 STAMPER LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3326
Practice Address - Country:US
Practice Address - Phone:706-300-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150270668163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology