Provider Demographics
NPI:1174161764
Name:HAXBY, MELINDA MERCEDES
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MERCEDES
Last Name:HAXBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51341
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-1341
Mailing Address - Country:US
Mailing Address - Phone:530-510-3319
Mailing Address - Fax:
Practice Address - Street 1:1914 BLOSSOM VIEW DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8861
Practice Address - Country:US
Practice Address - Phone:530-510-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide