Provider Demographics
NPI:1568071769
Name:MELROSE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MELROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W CIRCLE APT 2
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-7693
Mailing Address - Country:US
Mailing Address - Phone:304-588-4671
Mailing Address - Fax:
Practice Address - Street 1:220 W CIRCLE APT 2
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-7693
Practice Address - Country:US
Practice Address - Phone:304-588-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant