Provider Demographics
NPI:1487239281
Name:WRINKLE, MELISSA DARLENE (LPN)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DARLENE
Last Name:WRINKLE
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 1:2538 OLD HARRIMAN HWY
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-2733
Mailing Address - Country:US
Mailing Address - Phone:865-803-6824
Mailing Address - Fax:
Practice Address - Street 1:21 EDMONDS DR
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-1931
Practice Address - Country:US
Practice Address - Phone:865-730-3906
Practice Address - Fax:865-730-3937
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse