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General NPI Number Information
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NPI Number | 1932159845
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Entity Type | Individual
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Provider Name | MELANIE JOY/MCCOLLUM BODINE RN/CNNP
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 975 E 3RD ST BOX 159
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2103
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Country | US
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Telephone | 423-778-6170
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 COVINGTON COVE LN
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-1277
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Country | US
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Telephone | 423-886-1210
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | APN0000010881
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License Number State | TN
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