Provider Demographics
NPI:1457932626
Name:MELLO, COURTNEY (RN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ROSE
Other - Last Name:TOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2269 MIYA CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8125
Mailing Address - Country:US
Mailing Address - Phone:760-887-6905
Mailing Address - Fax:
Practice Address - Street 1:30 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2400
Practice Address - Country:US
Practice Address - Phone:800-478-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95198501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95198501OtherRN LICENSE