Healthcare Provider Details

I. General information

NPI: 1124559752
Provider Name (Legal Business Name): MELANIE NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

IV. Provider business mailing address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-4075
  • Fax: 406-723-3059
Mailing address:
  • Phone: 406-723-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10970496-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: