MEDICARE: MELVIS N NDE PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP1036661	DC

General Provider Information

NPI Number	:	1750636171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIS N NDE PMHNP

Provider Business Mailing Address
First Line	:	7808 HUBBLE DR
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2493
Country	:	US
Telephone Number	:	240-640-1512
Fax Number	:	202-545-0934

Provider Business Practice Location Address
First Line	:	611 DIVISION AVE NE STE 201
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5457
Country	:	US
Telephone Number	:	202-204-1361
Fax Number	:

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	10/23/2024

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