Provider Demographics
NPI:1972981652
Name:SMITH, MELISA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:A
Last Name:SMITH
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 1:1891 TWIN LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7303
Mailing Address - Country:US
Mailing Address - Phone:970-219-6093
Mailing Address - Fax:
Practice Address - Street 1:1891 TWIN LAKES CIR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7303
Practice Address - Country:US
Practice Address - Phone:970-219-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0184852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse