Provider Demographics
NPI:1336821842
Name:MELBA, VANESSA KATHLEEN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KATHLEEN
Last Name:MELBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2311
Mailing Address - Country:US
Mailing Address - Phone:681-432-0600
Mailing Address - Fax:
Practice Address - Street 1:1235 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2311
Practice Address - Country:US
Practice Address - Phone:681-432-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist