Provider Demographics
NPI:1568978575
Name:GLEAVE, MELISSA K (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:GLEAVE
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 40
Mailing Address - Street 2:
Mailing Address - City:JUNCTION
Mailing Address - State:UT
Mailing Address - Zip Code:84740-0040
Mailing Address - Country:US
Mailing Address - Phone:435-577-2521
Mailing Address - Fax:435-577-2521
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:UT
Practice Address - Zip Code:84740-8001
Practice Address - Country:US
Practice Address - Phone:435-577-2521
Practice Address - Fax:435-577-2521
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4885925-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health