Provider Demographics
NPI:1265942353
Name:KIZZIAR, MELANIE MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MICHELLE
Last Name:KIZZIAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1535 BEAR CLAW LANE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845
Mailing Address - Country:US
Mailing Address - Phone:260-450-9329
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DRIVE
Practice Address - Street 2:330
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-4684
Practice Address - Country:US
Practice Address - Phone:260-471-5114
Practice Address - Fax:260-471-5114
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28221817A163WH0500X, 163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis