Provider Demographics
NPI:1932103728
Name:TOTH, MELINDA A (CNS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:A
Last Name:TOTH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:A
Other - Last Name:LAVER-TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:PO BOX 8387
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-8387
Mailing Address - Country:US
Mailing Address - Phone:505-843-2922
Mailing Address - Fax:505-843-2931
Practice Address - Street 1:115 E COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6520
Practice Address - Country:US
Practice Address - Phone:505-623-2836
Practice Address - Fax:505-623-2841
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR46751364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ISSUEDMedicaid
P61694Medicare UPIN