Provider Demographics
NPI:1952766420
Name:CORREIA, MELINDA (RN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:EASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4318
Mailing Address - Country:US
Mailing Address - Phone:315-481-6723
Mailing Address - Fax:
Practice Address - Street 1:108 PARKER AVE
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4318
Practice Address - Country:US
Practice Address - Phone:315-481-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22696672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse