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General NPI Number Information
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NPI Number | 1265640783
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Entity Type | Individual
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Provider Name | MELANIE BOERIO
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1316 OLD HIGHWAY 63 S SUITE 200
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City | COLUMBIA
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State | MO
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Zip | 65201-6092
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Country | US
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Telephone | 573-445-4272
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Fax | 573-815-2477
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Provider Business Mailing Address
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Address Line | 5308 TIPTREE CT
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City | COLUMBIA
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State | MO
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Zip | 65203
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Country | US
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Telephone | 573-474-1054
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 135334
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License Number State | MO
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