Provider Demographics
NPI:1902235187
Name:MELOVIDOV, CHERYL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MELOVIDOV
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL ISLAND
Mailing Address - State:AK
Mailing Address - Zip Code:99660-0148
Mailing Address - Country:US
Mailing Address - Phone:907-546-8300
Mailing Address - Fax:907-546-8370
Practice Address - Street 1:1000 POLOVINA TURNPIKE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL ISLAND
Practice Address - State:AK
Practice Address - Zip Code:99660-0148
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:907-546-8370
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK32340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse