Provider Demographics
NPI:1942587142
Name:BURNETT GRIZZLE, MELAINE ALBERTA ROSALYN (RN)
Entity Type:Individual
Prefix:
First Name:MELAINE
Middle Name:ALBERTA ROSALYN
Last Name:BURNETT GRIZZLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELAINE
Other - Middle Name:ALBERTA
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:206 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2344
Mailing Address - Country:US
Mailing Address - Phone:407-846-0023
Mailing Address - Fax:407-483-1064
Practice Address - Street 1:206 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2344
Practice Address - Country:US
Practice Address - Phone:407-846-0023
Practice Address - Fax:407-483-1064
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9250738163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse