Provider Demographics
NPI:1902492408
Name:SCHMUCK, MELISSA KAY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:SCHMUCK
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 1:209 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1443
Mailing Address - Country:US
Mailing Address - Phone:304-265-3147
Mailing Address - Fax:
Practice Address - Street 1:992 SLATON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-8519
Practice Address - Country:US
Practice Address - Phone:304-290-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant