Provider Demographics
NPI:1144645219
Name:CORONADO, MELANY
Entity type:Individual
Prefix:
First Name:MELANY
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANY
Other - Middle Name:
Other - Last Name:RATZLAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:325 SNAKE RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2261
Mailing Address - Country:US
Mailing Address - Phone:208-798-4595
Mailing Address - Fax:
Practice Address - Street 1:325 SNAKE RIVER AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2261
Practice Address - Country:US
Practice Address - Phone:208-798-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-399224163W00000X
WARN60419633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse