Provider Demographics
NPI:1790285641
Name:DOOLEY, MELISSA Y
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:Y
Last Name:DOOLEY
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 1:7100 CARRIAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2905
Mailing Address - Country:US
Mailing Address - Phone:505-888-4434
Mailing Address - Fax:505-293-9899
Practice Address - Street 1:7100 CARRIAGE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2905
Practice Address - Country:US
Practice Address - Phone:505-888-4434
Practice Address - Fax:505-293-9899
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5855310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility