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General NPI Number Information
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NPI Number | 1255644506
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Entity Type | Individual
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Provider Name | ANNE CATHERINE MELVIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 2025 E NEWPORT AVE S217
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City | MILWAUKEE
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State | WI
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Zip | 53211-2906
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Country | US
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Telephone | 414-961-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S 2ND AVE
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City | ABBOTSFORD
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State | WI
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Zip | 54405-9530
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Country | US
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Telephone | 715-581-8181
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2625-23
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License Number State | WI
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