Provider Demographics
NPI:1457763435
Name:ELLIOTT, MELISSA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:ELLIOTT
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 1:3559 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-7515
Mailing Address - Country:US
Mailing Address - Phone:303-903-6232
Mailing Address - Fax:
Practice Address - Street 1:3559 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-7515
Practice Address - Country:US
Practice Address - Phone:303-903-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1622860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse