Provider Demographics
NPI:1912022088
Name:MELLO, LAURIE JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:JEAN
Last Name:MELLO
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 1:1080 EMELINE AVENUE
Mailing Address - Street 2:ROOM 104
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-454-4587
Mailing Address - Fax:831-454-4893
Practice Address - Street 1:1080 EMELINE AVENUE
Practice Address - Street 2:ROOM 104
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-454-4587
Practice Address - Fax:831-454-4893
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse