Katie Marie Melville, LPN

Individual provider Active NPI Licensed Practical Nurse · Cedar, MI

NPI 1386112720 · NPPES record last updated Nov 4, 2018

Key facts

NPI
1386112720
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
4703105847 (MI)
Practice address
13194 S Cedar Rd
Cedar, MI 49621-9581
Phone
(231) 357-3932
NPI assigned
Nov 4, 2018
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4703105847MIMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 4703105847 MI Yes

Addresses

Primary practice location

13194 S Cedar Rd
Cedar, MI 49621-9581

Mailing address

1169 Valley Dr
Traverse City, MI 49685-8920
Phone (616) 717-0247

Other providers in Cedar, MI

All providers in Cedar, MI · Licensed Practical Nurse in Michigan

Sources for this page

Verify at the official NPI Registry.