Provider Demographics
NPI:1639526064
Name:DEMARS, MELONIE JEANNE (LPN)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:JEANNE
Last Name:DEMARS
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 1:1701 E HALIFAX ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3920
Mailing Address - Country:US
Mailing Address - Phone:419-566-4034
Mailing Address - Fax:
Practice Address - Street 1:1701 E HALIFAX ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3920
Practice Address - Country:US
Practice Address - Phone:419-566-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP042342164W00000X
OHLP122123164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse