Healthcare Provider Details

I. General information

NPI: 1518424704
Provider Name (Legal Business Name): MELANIE SHARI KIRVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 PEGGY RD SE STE F
RIO RANCHO NM
87124-1035
US

IV. Provider business mailing address

6444 DUERO PL NW
ALBUQUERQUE NM
87114-4994
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-1746
  • Fax:
Mailing address:
  • Phone: 505-261-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberC037074
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: