Provider Demographics
NPI:1033946769
Name:WHITEHOUSES-HOLCOMB, MELISSA JO
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:WHITEHOUSES-HOLCOMB
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 1:1946 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-1607
Mailing Address - Country:US
Mailing Address - Phone:563-293-0505
Mailing Address - Fax:
Practice Address - Street 1:1946 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1607
Practice Address - Country:US
Practice Address - Phone:563-293-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251K00000X, 261QC1500X, 372500000X, 372600000X, 376J00000X, 253Z00000X
IA510LL3327347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker