Provider Demographics
NPI:1447708276
Name:MELENDEZ, JOLEEN (RN)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:MELENDEZ
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 1:615 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2021
Mailing Address - Country:US
Mailing Address - Phone:541-218-7702
Mailing Address - Fax:541-779-0107
Practice Address - Street 1:18 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7471
Practice Address - Country:US
Practice Address - Phone:541-779-0100
Practice Address - Fax:541-779-0107
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242273RN163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn