Healthcare Provider Details

I. General information

NPI: 1568692226
Provider Name (Legal Business Name): MELISSA MARIE CASSELBERRY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12613 BERLIN RD APT A
BERLIN HEIGHTS OH
44814-9507
US

IV. Provider business mailing address

12613 BERLIN RD APT A
BERLIN HEIGHTS OH
44814-9507
US

V. Phone/Fax

Practice location:
  • Phone: 419-677-6307
  • Fax:
Mailing address:
  • Phone: 419-677-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 131310IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: