MEDICARE: MELANIE ANNE JURON RN

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	163W00000X	Registered Nurse	111118230	WI

General Provider Information

NPI Number	:	1730913112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ANNE JURON RN

Provider Business Mailing Address
First Line	:	1315 CRYSTAL COVE TRL UNIT 3
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 CRYSTAL COVE TRL UNIT 3
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4298
Country	:	US
Telephone Number	:	847-848-8036
Fax Number	:

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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