Provider Demographics
NPI:1639907207
Name:CHISHOLM, MELISA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:MARIE
Last Name:CHISHOLM
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 1:10821 INGALLS CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3140
Mailing Address - Country:US
Mailing Address - Phone:720-327-4079
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 330
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3669
Practice Address - Country:US
Practice Address - Phone:303-318-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO168198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse