Provider Demographics
NPI:1356556260
Name:MARCUM, MELISSA (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARCUM
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 1:406 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3125
Mailing Address - Country:US
Mailing Address - Phone:603-837-2388
Mailing Address - Fax:
Practice Address - Street 1:149 S BAILEY HAZEN RD
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:VT
Practice Address - Zip Code:05042
Practice Address - Country:US
Practice Address - Phone:802-584-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0250007641164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse