Provider Demographics
NPI:1851990964
Name:KOIS, MELISSA LOREN (DIRECT CARE WORKER)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOREN
Last Name:KOIS
Suffix:
Gender:F
Credentials:DIRECT CARE WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CONNECTOR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5665
Mailing Address - Country:US
Mailing Address - Phone:304-261-8617
Mailing Address - Fax:304-551-0075
Practice Address - Street 1:153 CONNECTOR RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5665
Practice Address - Country:US
Practice Address - Phone:304-261-8617
Practice Address - Fax:304-551-0075
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty