Provider Demographics
NPI:1689288789
Name:STANLEY, MELISSA NICHOLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICHOLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 COLLEGE HL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3303
Mailing Address - Country:US
Mailing Address - Phone:304-601-2413
Mailing Address - Fax:
Practice Address - Street 1:707 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3303
Practice Address - Country:US
Practice Address - Phone:304-601-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant