Provider Demographics
NPI:1558593913
Name:DAVIS, MELINA (RN)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:DAVIS
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 1:4088 KEHRER RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9558
Mailing Address - Country:US
Mailing Address - Phone:419-985-3131
Mailing Address - Fax:419-985-3131
Practice Address - Street 1:4088 KEHRER RD
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-9558
Practice Address - Country:US
Practice Address - Phone:419-985-3131
Practice Address - Fax:419-985-3131
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN285278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse