Healthcare Provider Details

I. General information

NPI: 1689820003
Provider Name (Legal Business Name): MELODY MARIE REID LNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 HUNTERS CT
NEWARK OH
43055-9269
US

IV. Provider business mailing address

449 HUNTERS CT
NEWARK OH
43055-9269
US

V. Phone/Fax

Practice location:
  • Phone: 740-364-1981
  • Fax:
Mailing address:
  • Phone: 740-364-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN099982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: