Provider Demographics
NPI:1720150386
Name:CONGROVE, MELISSA JO (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:CONGROVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10480 STATE ROUTE 180
Mailing Address - Street 2:
Mailing Address - City:LAURELVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43135-9621
Mailing Address - Country:US
Mailing Address - Phone:740-655-3291
Mailing Address - Fax:
Practice Address - Street 1:10480 STATE ROUTE 180
Practice Address - Street 2:
Practice Address - City:LAURELVILLE
Practice Address - State:OH
Practice Address - Zip Code:43135-9621
Practice Address - Country:US
Practice Address - Phone:740-655-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse