Provider Demographics
NPI:1053722454
Name:MELVIN, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MELVIN
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 1:55 MONUMENT WALK
Mailing Address - Street 2:APT. 4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1760
Mailing Address - Country:US
Mailing Address - Phone:856-266-2015
Mailing Address - Fax:
Practice Address - Street 1:55 MONUMENT WALK
Practice Address - Street 2:APT. 4D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1760
Practice Address - Country:US
Practice Address - Phone:856-266-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse