Provider Demographics
NPI:1801499744
Name:MELAAS, CRYSTAL JOY
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOY
Last Name:MELAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:MADDOCK
Mailing Address - State:ND
Mailing Address - Zip Code:58348-0371
Mailing Address - Country:US
Mailing Address - Phone:701-351-0460
Mailing Address - Fax:
Practice Address - Street 1:501 WESTERN AVE N
Practice Address - Street 2:
Practice Address - City:MADDOCK
Practice Address - State:ND
Practice Address - Zip Code:58348
Practice Address - Country:US
Practice Address - Phone:701-351-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14637323747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant