Provider Demographics
NPI:1174765374
Name:PAUL, MELISSA ANN (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PAUL
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 1:208 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1302
Mailing Address - Country:US
Mailing Address - Phone:315-363-0954
Mailing Address - Fax:
Practice Address - Street 1:208 ALLEN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1302
Practice Address - Country:US
Practice Address - Phone:315-363-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294873164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse