Healthcare Provider Details

I. General information

NPI: 1689988735
Provider Name (Legal Business Name): MARVELLA MATTMILLER MELNICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2010
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SARAH LN
CABOT AR
72023-9438
US

IV. Provider business mailing address

10110 W MARKHAM ST
LITTLE ROCK AR
72205-2173
US

V. Phone/Fax

Practice location:
  • Phone: 501-843-5046
  • Fax:
Mailing address:
  • Phone: 501-227-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR11269
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: