=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659437523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE PEPPER CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8117 LODEN CT
-----------------------------------------------------
City | BLACKLICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43004-9225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-866-3639
-----------------------------------------------------
Fax | 614-860-9118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8117 LODEN CT
-----------------------------------------------------
City | BLACKLICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43004-9225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-866-3639
-----------------------------------------------------
Fax | 614-860-9118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LN0005X
-----------------------------------------------------
Taxonomy Name | Critical Care Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 174444
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LN0005X
-----------------------------------------------------
Taxonomy Name | Critical Care Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 26NN09851300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------