Provider Demographics
NPI:1790040202
Name:MCENDREE, MELANIE (LMT,NMT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:MCENDREE
Suffix:
Gender:F
Credentials:LMT,NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LOBLOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3513
Mailing Address - Country:US
Mailing Address - Phone:843-751-6017
Mailing Address - Fax:
Practice Address - Street 1:105 LOBOLLY DR.
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-751-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7719172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker