Provider Demographics
NPI:1952647570
Name:MELJAC, MELISSA ANN (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MELJAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1987 BARRETT CT
Mailing Address - Street 2:APT. 105
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4953
Mailing Address - Country:US
Mailing Address - Phone:641-781-0227
Mailing Address - Fax:
Practice Address - Street 1:1987 BARRETT CT
Practice Address - Street 2:APT. 105
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4953
Practice Address - Country:US
Practice Address - Phone:641-781-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138641-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI138641-30OtherRN COMPACT LICENSE