Provider Demographics
NPI:1790021350
Name:WRIGHT, MELINDA S (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:S
Other - Last Name:REVOLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2877 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4852
Mailing Address - Country:US
Mailing Address - Phone:414-232-0556
Mailing Address - Fax:
Practice Address - Street 1:2877 N 81ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4852
Practice Address - Country:US
Practice Address - Phone:414-232-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI155986-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse