Provider Demographics
NPI:1801606421
Name:CLITES, MELINDA (RN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CLITES
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 1:1314 EDWIN MILLER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5717
Mailing Address - Country:US
Mailing Address - Phone:304-728-1750
Mailing Address - Fax:
Practice Address - Street 1:1314 EDWIN MILLER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5717
Practice Address - Country:US
Practice Address - Phone:304-728-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37395163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty