Provider Demographics
NPI:1023243367
Name:MCCALLISTER, MELONESE (0001199288)
Entity type:Individual
Prefix:
First Name:MELONESE
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:0001199288
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 TYRE NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3158
Mailing Address - Country:US
Mailing Address - Phone:757-673-3243
Mailing Address - Fax:
Practice Address - Street 1:3604 TYRE NECK RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3158
Practice Address - Country:US
Practice Address - Phone:757-673-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001199288163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health