Provider Demographics
NPI:1770179251
Name:BURNETT, MELISSA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:BURNETT
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 1:1232 STONEY RUN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16340-6322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-3547
Practice Address - Country:US
Practice Address - Phone:716-487-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706059163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health