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General NPI Number Information
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NPI Number | 1194550111
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Entity Type | Organization
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Legal Business Name | MELANIE JO DRAKE MD PLLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 3350 AMERICANA TERRACE SUITE 360-C
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City | BOISE
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State | ID
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Zip | 83706
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Country | US
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Telephone | 208-722-0899
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Fax | 208-205-8031
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Provider Business Mailing Address
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Address Line | 1116 S VISTA AVE PMB 235
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City | BOISE
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State | ID
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Zip | 83705
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Country | US
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Telephone | 208-722-0899
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Fax | 208-205-8031
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE JO DRAKE
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Credential | MD
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Telephone | 208-722-0899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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