Provider Demographics
NPI:1760808331
Name:MELBY, LORIANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORIANN
Middle Name:
Last Name:MELBY
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 1:16320 W MARIETTA DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6594
Mailing Address - Country:US
Mailing Address - Phone:262-794-3719
Mailing Address - Fax:
Practice Address - Street 1:16320 W MARIETTA DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-6594
Practice Address - Country:US
Practice Address - Phone:262-794-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120469-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse