Provider Demographics
NPI:1508479346
Name:MELTON, JOEZETTE (INDIVIDUAL PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:JOEZETTE
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:INDIVIDUAL PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 EAST MAIN STREET APT 605
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2484
Mailing Address - Country:US
Mailing Address - Phone:330-238-6859
Mailing Address - Fax:
Practice Address - Street 1:449 EAST MAIN STREET APT 605
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2484
Practice Address - Country:US
Practice Address - Phone:330-238-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2454786374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2454786Medicaid