MEDICARE: MELISSA LEE MAES FNP

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
1	363LF0000X	Family Nurse Practitioner	#AP1636	AZ

General Provider Information

NPI Number	:	1114992385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LEE MAES FNP

Provider Business Mailing Address
First Line	:	1353 E FORT LOWELL RD
Second Line	:	UNIT A
City	:	TUCSON
State	:	AZ
Zip	:	85719-2208
Country	:	US
Telephone Number	:	520-495-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 E FORT LOWELL RD
Second Line	:	UNIT A
City	:	TUCSON
State	:	AZ
Zip	:	85719-2208
Country	:	US
Telephone Number	:	520-495-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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