Individual
LORA MELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
153 LEO LN, WASHINGTON, WV 26181-8466
(681) 588-7715
Mailing address
153 LEO LN, WASHINGTON, WV 26181-8466
(681) 588-7715
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
36191
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630435
WORKERS COMP
—
Enumeration date
10/24/2022
Last updated
10/24/2022
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