Provider Demographics
NPI:1952646432
Name:MEDINA, MELISSA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:MEDINA
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 1:39 COLLECTOR LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5234
Mailing Address - Country:US
Mailing Address - Phone:516-426-1812
Mailing Address - Fax:
Practice Address - Street 1:39 COLLECTOR LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5234
Practice Address - Country:US
Practice Address - Phone:516-426-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse