Provider Demographics
NPI:1245111590
Name:TAYLOR/HEIDEMAN, MELANIE TAYLOR (CNA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:TAYLOR
Last Name:TAYLOR/HEIDEMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35008 STICES GULCH RD
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-7743
Mailing Address - Country:US
Mailing Address - Phone:541-406-9689
Mailing Address - Fax:
Practice Address - Street 1:35008 STICES GULCH RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-7743
Practice Address - Country:US
Practice Address - Phone:541-406-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201805603CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide