Provider Demographics
NPI:1710506126
Name:MELIDEM, OBIALUNANMA
Entity Type:Individual
Prefix:
First Name:OBIALUNANMA
Middle Name:
Last Name:MELIDEM
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 1:13903 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6844
Mailing Address - Country:US
Mailing Address - Phone:240-988-2393
Mailing Address - Fax:
Practice Address - Street 1:13903 FLOYD ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6844
Practice Address - Country:US
Practice Address - Phone:240-988-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009067163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical