Provider Demographics
NPI:1447009113
Name:MERRITT, MELANIE D (LPN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803A 5TH CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7904
Mailing Address - Country:US
Mailing Address - Phone:360-480-2007
Mailing Address - Fax:
Practice Address - Street 1:9474 LATHROP INDUSTRIAL DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-583-3340
Practice Address - Fax:360-322-3804
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00051869164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse