Provider Demographics
NPI:1932894458
Name:MELENDEZ, ELISEA IVETTE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:ELISEA
Middle Name:IVETTE
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10377 CHEROKEE CORNER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4536
Mailing Address - Country:US
Mailing Address - Phone:702-428-1765
Mailing Address - Fax:
Practice Address - Street 1:10377 CHEROKEE CORNER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-4536
Practice Address - Country:US
Practice Address - Phone:702-428-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842183163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health