Provider Demographics
NPI:1043517444
Name:STATEN, MELINDA A (RN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:A
Last Name:STATEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16914 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1566
Mailing Address - Country:US
Mailing Address - Phone:216-283-4624
Mailing Address - Fax:
Practice Address - Street 1:16914 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1566
Practice Address - Country:US
Practice Address - Phone:216-283-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.118558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse