MEDICARE: MELODY TANIS HORNER C.N.

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1780902338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY TANIS HORNER C.N.

Provider Business Mailing Address
First Line	:	9104 SUMMERTIME LN
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4558
Country	:	US
Telephone Number	:	310-559-7953
Fax Number	:

Provider Business Practice Location Address
First Line	:	9104 SUMMERTIME LN
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4558
Country	:	US
Telephone Number	:	310-559-7953
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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