Provider Demographics
NPI:1851160915
Name:NICKLOW, MELONEY JOANN
Entity Type:Individual
Prefix:
First Name:MELONEY
Middle Name:JOANN
Last Name:NICKLOW
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 1:587 DUNKARD AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4115
Mailing Address - Country:US
Mailing Address - Phone:304-216-1013
Mailing Address - Fax:
Practice Address - Street 1:587 DUNKARD AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-4115
Practice Address - Country:US
Practice Address - Phone:304-216-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant