Individual
MELISSA MANTOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
BUILDING 301 ANDREWS AVE., LYSTER ARMY HEALTH CLINIC, FORT RUCKER, AL 36362-5333
(334) 255-7930
Mailing address
BUILDING 301 ANDREWS AVE., LYSTER ARMY HEALTH CLINIC, FORT RUCKER, AL 36362-5333
(334) 255-7930
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2066467
AL
164W00000X
Licensed Practical Nurse
LPN16824
HI
164W00000X
Licensed Practical Nurse
P324855
MS
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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