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NPI Code Detail

MEDICARE: MELISSA LEE BROWN PEER SUPPORTER

MEDICARE: MELISSA LEE BROWN PEER SUPPORTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist
2175T00000XPeer SpecialistAPS.004552OH

General Provider Information

NPI Number : 1114786548
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LEE BROWN PEER SUPPORTER
Provider Business Mailing Address
First Line : 7058 CORPORATE WAY STE 3
Second Line :
City : DAYTON
State : OH
Zip : 45459-4243
Country : US
Telephone Number : 937-991-0080
Fax Number : 937-991-0080
Provider Business Practice Location Address
First Line : 7058 CORPORATE WAY STE 3
Second Line :
City : DAYTON
State : OH
Zip : 45459-4243
Country : US
Telephone Number : 937-991-0080
Fax Number : 937-991-3083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2024
Last Update Date : 07/13/2024

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