Provider Demographics
NPI:1578941480
Name:CARR, MELISSA DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:CARR
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 1:22448 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2408
Mailing Address - Country:US
Mailing Address - Phone:586-776-6927
Mailing Address - Fax:
Practice Address - Street 1:22448 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2408
Practice Address - Country:US
Practice Address - Phone:586-776-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703090251164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse