Provider Demographics
NPI:1619867462
Name:WALDRON, MELISSA LAVON
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LAVON
Last Name:WALDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LAVON
Other - Last Name:SIDLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2657 BARNARD RD
Mailing Address - Street 2:
Mailing Address - City:ROCA
Mailing Address - State:NE
Mailing Address - Zip Code:68430-4445
Mailing Address - Country:US
Mailing Address - Phone:402-419-3193
Mailing Address - Fax:
Practice Address - Street 1:2657 BARNARD RD
Practice Address - Street 2:
Practice Address - City:ROCA
Practice Address - State:NE
Practice Address - Zip Code:68430-4445
Practice Address - Country:US
Practice Address - Phone:402-419-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant