Provider Demographics
NPI:1053021246
Name:ANDERSON, MEL ANN
Entity type:Individual
Prefix:
First Name:MEL
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-8996
Mailing Address - Country:US
Mailing Address - Phone:765-472-8049
Mailing Address - Fax:765-475-8895
Practice Address - Street 1:269 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-8996
Practice Address - Country:US
Practice Address - Phone:765-472-8049
Practice Address - Fax:765-475-8895
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27075656A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse