Provider Demographics
NPI:1629644240
Name:PORTER, MELANIE ELIZA (LPN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELIZA
Last Name:PORTER
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 1:4530 LOGAN WAY APT 6
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3322
Mailing Address - Country:US
Mailing Address - Phone:330-208-4821
Mailing Address - Fax:
Practice Address - Street 1:4530 LOGAN WAY APT 6
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3322
Practice Address - Country:US
Practice Address - Phone:330-208-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.167624.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse