MEDICARE: MELISSA MARCUM LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	0250007641	VT

General Provider Information

NPI Number	:	1356556260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARCUM LPN

Provider Business Mailing Address
First Line	:	406 JEFFERSON RD
Second Line	:
City	:	WHITEFIELD
State	:	NH
Zip	:	03598-3125
Country	:	US
Telephone Number	:	603-837-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 S BAILEY HAZEN RD
Second Line	:
City	:	RYEGATE
State	:	VT
Zip	:	05042
Country	:	US
Telephone Number	:	802-584-4679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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