Healthcare Provider Details

I. General information

NPI: 1740565704
Provider Name (Legal Business Name): MELANI REAUME VOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W LAKE LANSING RD SUITE C 120
EAST LANSING MI
48823-8445
US

IV. Provider business mailing address

5116 GRATIOT AVE
SAINT CLAIR MI
48079
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-0957
  • Fax:
Mailing address:
  • Phone: 810-824-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006145
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: