Provider Demographics
NPI:1689445504
Name:DEETS, MELISSA ELAINE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:DEETS
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3262
Mailing Address - Country:US
Mailing Address - Phone:816-286-3490
Mailing Address - Fax:
Practice Address - Street 1:5808 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3262
Practice Address - Country:US
Practice Address - Phone:816-286-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017022403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse