Provider Demographics
NPI:1770609158
Name:KREISEL, MELINDA LEE (RN)
Entity type:Individual
Prefix:MR
First Name:MELINDA
Middle Name:LEE
Last Name:KREISEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1314
Mailing Address - Country:US
Mailing Address - Phone:410-879-5515
Mailing Address - Fax:
Practice Address - Street 1:3104 ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1314
Practice Address - Country:US
Practice Address - Phone:410-879-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO72950163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health