Provider Demographics
NPI:1871037986
Name:SAMOL, MELANIE H (LPN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:H
Last Name:SAMOL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-1746
Mailing Address - Country:US
Mailing Address - Phone:864-984-3067
Mailing Address - Fax:864-984-5749
Practice Address - Street 1:301 HENRY ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-1746
Practice Address - Country:US
Practice Address - Phone:864-984-3067
Practice Address - Fax:864-984-5749
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP25914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse