Provider Demographics
NPI:1558913590
Name:VELASCO, MELISSA (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VELASCO
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 1:955 GARRISON RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5157
Mailing Address - Country:US
Mailing Address - Phone:865-712-9641
Mailing Address - Fax:
Practice Address - Street 1:955 GARRISON RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5157
Practice Address - Country:US
Practice Address - Phone:865-712-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN000073065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse