Healthcare Provider Details

I. General information

NPI: 1255295150
Provider Name (Legal Business Name): MELISSA LYNN FOURIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N ALMA SCHOOL RD
CHANDLER AZ
85224-4363
US

IV. Provider business mailing address

1690 S SAN TAN VILLAGE PKWY APT 3083
GILBERT AZ
85295-9800
US

V. Phone/Fax

Practice location:
  • Phone: 480-571-5541
  • Fax:
Mailing address:
  • Phone: 480-771-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: