Provider Demographics
NPI:1922332980
Name:BENEVIDES, MELISSA JOELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOELLE
Last Name:BENEVIDES
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 1:135 THURBER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02725-1813
Mailing Address - Country:US
Mailing Address - Phone:508-642-3477
Mailing Address - Fax:
Practice Address - Street 1:135 THURBER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-1813
Practice Address - Country:US
Practice Address - Phone:508-642-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85676164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse