Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | COA10168NP | OH |
NPI | 1003062670 |
---|---|
Provider Name | Teresa E. Mellington |
First Address | Youngstown, OH 44501-1096 |
Second Address | Youngstown, OH 44501-1096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 13/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2924143 | (05) | OH |
H125570 | MEDICARE PTAN (01) | OH |