MEDICARE: MRS. STEPHANIE CLARE MELLOR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	L1-0025967	DE

General Provider Information

NPI Number	:	1912238585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE CLARE MELLOR RN

Provider Business Mailing Address
First Line	:	PO BOX 4010
Second Line	:	313 SOUTH FIFTH STREET
City	:	ODESSA
State	:	DE
Zip	:	19730-4010
Country	:	US
Telephone Number	:	302-376-4128
Fax Number	:	302-378-5139

Provider Business Practice Location Address
First Line	:	1221 CEDAR LANE RD
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-9636
Country	:	US
Telephone Number	:	302-449-5878
Fax Number	:	302-378-5139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	12/05/2023

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