Provider Demographics
NPI:1790374189
Name:HORNECK, MELISSA (RN BSN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HORNECK
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 E MAYO BLVD APT 7305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5644
Mailing Address - Country:US
Mailing Address - Phone:917-679-3782
Mailing Address - Fax:
Practice Address - Street 1:10 E DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2821
Practice Address - Country:US
Practice Address - Phone:602-371-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN239668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse