Provider Demographics
NPI:1952606980
Name:WILLIAMSON, MELISSA JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO
Last Name:WILLIAMSON
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 1:2330 COUNTY ROAD 2175
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9719
Mailing Address - Country:US
Mailing Address - Phone:419-908-3078
Mailing Address - Fax:
Practice Address - Street 1:2330 COUNTY ROAD 2175
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9719
Practice Address - Country:US
Practice Address - Phone:419-908-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN098242-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse