Provider Demographics
NPI:1245076934
Name:GREENOUGH, MELANIE (LPN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:GREENOUGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-2622
Mailing Address - Country:US
Mailing Address - Phone:518-744-4072
Mailing Address - Fax:
Practice Address - Street 1:25 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5882
Practice Address - Country:US
Practice Address - Phone:518-926-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269477-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse