Provider Demographics
NPI:1053170688
Name:COTTON, MELANIE STAR DENISE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:STAR DENISE
Last Name:COTTON
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 1:316 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2829
Mailing Address - Country:US
Mailing Address - Phone:585-557-1724
Mailing Address - Fax:
Practice Address - Street 1:316 FLINT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2829
Practice Address - Country:US
Practice Address - Phone:585-557-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347035164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse