Healthcare Provider Details

I. General information

NPI: 1104848522
Provider Name (Legal Business Name): MELANIE S KLEIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MARTIN LUTHER KING JR DR
CLEVELAND OH
44104-3815
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-448-6420
  • Fax: 216-448-6015
Mailing address:
  • Phone: 440-684-5829
  • Fax: 440-449-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5862-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: