Provider Demographics
NPI:1982206512
Name:MICHELETTI, MELISSA ANNE (BSN, RN, CLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MICHELETTI
Suffix:
Gender:F
Credentials:BSN, RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CREDIBLE LOOP
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8864
Mailing Address - Country:US
Mailing Address - Phone:469-992-5871
Mailing Address - Fax:
Practice Address - Street 1:318 CREDIBLE LOOP
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-8864
Practice Address - Country:US
Practice Address - Phone:469-992-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-24
Deactivation Date:2020-11-10
Deactivation Code:
Reactivation Date:2020-11-24
Provider Licenses
StateLicense IDTaxonomies
NMRN-75172163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant