Healthcare Provider Details

I. General information

NPI: 1407830284
Provider Name (Legal Business Name): MELANIE SUE ARNTZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N EGAN AVE
BURNS OR
97720-1741
US

IV. Provider business mailing address

229 N EGAN AVE
BURNS OR
97720-1741
US

V. Phone/Fax

Practice location:
  • Phone: 541-573-6126
  • Fax:
Mailing address:
  • Phone: 541-573-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000026638N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: