Healthcare Provider Details

I. General information

NPI: 1225218514
Provider Name (Legal Business Name): MELANIE LENA CUISON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E PLAZA CIR
LITCHFIELD PARK AZ
85340-4930
US

IV. Provider business mailing address

25726 W ST KATERI DR
BUCKEYE AZ
85326-2132
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-6000
  • Fax:
Mailing address:
  • Phone: 623-547-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP031530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: