Provider Demographics
NPI:1427767938
Name:MIDCAP, MELISSA LU
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LU
Last Name:MIDCAP
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 1:7421 WETZEL TYLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-7403
Mailing Address - Country:US
Mailing Address - Phone:304-904-6211
Mailing Address - Fax:
Practice Address - Street 1:7421 WETZEL TYLER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-7403
Practice Address - Country:US
Practice Address - Phone:304-904-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse