Provider Demographics
NPI:1144084831
Name:ROTH, MELIA (MSNED, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSNED, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9642
Mailing Address - Country:US
Mailing Address - Phone:330-883-4619
Mailing Address - Fax:
Practice Address - Street 1:5100 BELMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1043
Practice Address - Country:US
Practice Address - Phone:330-333-6404
Practice Address - Fax:330-545-5919
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035850363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner