MEDICARE: MRS. MELANIE SARAH ALVARADO MSN, ANP-BC, GNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	754657	TX
2	363LG0600X	Gerontology Nurse Practitioner	754657	TX

General Provider Information

NPI Number	:	1649523325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE SARAH ALVARADO MSN, ANP-BC, GNP-BC

Provider Business Mailing Address
First Line	:	717 W LAMPASAS ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-4533
Country	:	US
Telephone Number	:	972-875-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 W LAMPASAS ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-4533
Country	:	US
Telephone Number	:	972-875-6790
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	04/08/2013

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