MEDICARE: MELODIE NANNENGA OD

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	152W00000X	Optometrist	1520	AZ

General Provider Information

NPI Number	:	1568495521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODIE NANNENGA OD

Provider Business Mailing Address
First Line	:	12036E VIA DE PALMAS
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-3405
Country	:	US
Telephone Number	:	612-382-1979
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-4201
Country	:	US
Telephone Number	:	480-281-0271
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/17/2015

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Directions to “ MELODIE NANNENGA OD” Practice Location

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