MEDICARE: MRS. MELANIE WARREN CRNP

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	363LW0102X	Women's Health Nurse Practitioner	1-148948	AL
2	363LF0000X	Family Nurse Practitioner	1-148948	AL

General Provider Information

NPI Number	:	1205589785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE WARREN CRNP

Provider Business Mailing Address
First Line	:	3735 CORPORATE WOODS DR STE 105
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35242-2296
Country	:	US
Telephone Number	:	205-900-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 CORPORATE WOODS DR STE 105
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35242-2296
Country	:	US
Telephone Number	:	205-900-7337
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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