Healthcare Provider Details

I. General information

NPI: 1114992385
Provider Name (Legal Business Name): MELISSA LEE MAES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 E FORT LOWELL RD UNIT A
TUCSON AZ
85719-2208
US

IV. Provider business mailing address

1353 E FORT LOWELL RD UNIT A
TUCSON AZ
85719-2208
US

V. Phone/Fax

Practice location:
  • Phone: 520-495-2100
  • Fax:
Mailing address:
  • Phone: 520-495-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number#AP1636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: