Provider Demographics
NPI:1508220005
Name:JABLONSKI, MELODY (NP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 COFFEE TREE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2230
Mailing Address - Country:US
Mailing Address - Phone:314-892-6618
Mailing Address - Fax:
Practice Address - Street 1:3642 COFFEE TREE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2230
Practice Address - Country:US
Practice Address - Phone:314-223-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF0216682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily