Provider Demographics
NPI:1689988735
Name:MELNICK, MARVELLA MATTMILLER (RN)
Entity Type:Individual
Prefix:
First Name:MARVELLA
Middle Name:MATTMILLER
Last Name:MELNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2173
Mailing Address - Country:US
Mailing Address - Phone:501-227-9700
Mailing Address - Fax:
Practice Address - Street 1:1 SARAH LN
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-9438
Practice Address - Country:US
Practice Address - Phone:501-843-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR11269163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse