Provider Demographics
NPI:1518368075
Name:OLOUGHLIN, MELISSA (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:OLOUGHLIN
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0542
Mailing Address - Country:US
Mailing Address - Phone:802-310-4157
Mailing Address - Fax:
Practice Address - Street 1:324 SOUTH BAYLEY HAZEN RD
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:VT
Practice Address - Zip Code:05042
Practice Address - Country:US
Practice Address - Phone:802-310-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0260102914163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse