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NPI Code Detail

MEDICARE: MELISSA LASALLE

MEDICARE: MELISSA LASALLE
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
1363LF0000XFamily Nurse PractitionerARNP9289335FL

General Provider Information

NPI Number : 1922340041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LASALLE
Provider Business Mailing Address
First Line : 12904 153RD CT N
Second Line :
City : JUPITER
State : FL
Zip : 33478-6612
Country : US
Telephone Number : 954-448-4167
Fax Number :
Provider Business Practice Location Address
First Line : 12295 BISCAYNE BLVD
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33181-2713
Country : US
Telephone Number : 866-825-3227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2013
Last Update Date : 08/02/2020

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Directions to “ MELISSA LASALLE ” Practice Location

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