Healthcare Provider Details

I. General information

NPI: 1205040722
Provider Name (Legal Business Name): ELIZABETH MELANCON CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETSY MELANCON CPM

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S 8TH ST
LAS VEGAS NV
89104-1546
US

IV. Provider business mailing address

1255 S 8TH ST
LAS VEGAS NV
89104-1546
US

V. Phone/Fax

Practice location:
  • Phone: 702-672-1424
  • Fax: 702-731-5356
Mailing address:
  • Phone: 702-672-1424
  • Fax: 702-731-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNONE
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: