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General NPI Number Information
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NPI Number | 1013240654
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Entity Type | Individual
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Provider Name | MRS. MELISSA JEAN ATWATER
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Gender | Female
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 119 BIG BEND WAY
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City | WARNERS
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State | NY
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Zip | 13164-3702
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Country | US
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Telephone | 352-432-3998
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Fax | 352-432-3999
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Provider Business Mailing Address
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Address Line | 591 HERNANDO PL
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City | CLERMONT
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State | FL
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Zip | 34715-8069
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Country | US
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Telephone | 352-432-3809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1212916182
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License Number State | NY
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