Provider Demographics
NPI:1962846691
Name:DYCK, MELISSA KRISTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KRISTINE
Last Name:DYCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E SAGEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4934
Mailing Address - Country:US
Mailing Address - Phone:623-535-6318
Mailing Address - Fax:623-935-9536
Practice Address - Street 1:4095 NORTH 144TH AVE.
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:623-535-6318
Practice Address - Fax:623-935-9536
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse