Provider Demographics
NPI:1952047730
Name:KONDRACKI, MELINDA GAIL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:GAIL
Last Name:KONDRACKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:GAIL
Other - Last Name:USSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9655
Mailing Address - Country:US
Mailing Address - Phone:937-869-3071
Mailing Address - Fax:
Practice Address - Street 1:3100 HARPER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-9655
Practice Address - Country:US
Practice Address - Phone:937-869-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide