Healthcare Provider Details

I. General information

NPI: 1033134457
Provider Name (Legal Business Name): MELANIE J WARE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE J DYAE

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E WASHINGTON AVE
NORTH LITTLE ROCK AR
72114-5853
US

IV. Provider business mailing address

1021 E WASHINGTON AVE
NORTH LITTLE ROCK AR
72114-5853
US

V. Phone/Fax

Practice location:
  • Phone: 501-376-6694
  • Fax: 501-376-6695
Mailing address:
  • Phone: 501-376-6694
  • Fax: 501-376-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberM01021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: