Provider Demographics
NPI:1710433941
Name:CARR, MELITA JOY
Entity Type:Individual
Prefix:
First Name:MELITA
Middle Name:JOY
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELITA
Other - Middle Name:JOY
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2029 YOUNGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-980-4823
Mailing Address - Fax:
Practice Address - Street 1:2029 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4312
Practice Address - Country:US
Practice Address - Phone:330-980-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse