Provider Demographics
NPI:1811205693
Name:MELLON, RITA LORRAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:LORRAINE
Last Name:MELLON
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 1:9915 S CAMINO DE LA CALINDA
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2039
Mailing Address - Country:US
Mailing Address - Phone:520-207-5506
Mailing Address - Fax:
Practice Address - Street 1:9915 S CAMINO DE LA CALINDA
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2039
Practice Address - Country:US
Practice Address - Phone:520-207-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse