Healthcare Provider Details

I. General information

NPI: 1972183283
Provider Name (Legal Business Name): MELISSA MENEFEE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 13TH ST NW
CANTON OH
44708-3116
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-8100
US

V. Phone/Fax

Practice location:
  • Phone: 330-588-2212
  • Fax:
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number134900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: