Healthcare Provider Details

I. General information

NPI: 1265640783
Provider Name (Legal Business Name): MELANIE BOERIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 OLD HIGHWAY 63 S SUITE 200
COLUMBIA MO
65201-6092
US

IV. Provider business mailing address

5308 TIPTREE CT
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-4272
  • Fax: 573-815-2477
Mailing address:
  • Phone: 573-474-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number135334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: