MEDICARE: MELISSA ANNE WORLEY IDMT

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	146L00000X	Paramedic	P8010457
2	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1427292226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE WORLEY IDMT

Provider Business Mailing Address
First Line	:	PSC 80 BOX 12823
Second Line	:
City	:	APO
State	:	AP
Zip	:	96367
Country	:	US
Telephone Number	:	970-373-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 3531
Second Line	:	KADENA AB JAPAN
City	:	APO
State	:	AP
Zip	:	96368
Country	:	US
Telephone Number	:	011816117349156
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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