MEDICARE: MS. MELENNA JANE VALLIERE RN

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	261Q00000X	Clinic/Center	RN 084394	MD

General Provider Information

NPI Number	:	1235226119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELENNA JANE VALLIERE RN

Provider Business Mailing Address
First Line	:	CMR 416
Second Line	:	BOX 280
City	:	APO
State	:	AE
Zip	:	09140
Country	:	US
Telephone Number	:	011499841
Fax Number	:	834834

Provider Business Practice Location Address
First Line	:	USAMEDDAC WUERZBURG
Second Line	:	ILLESHEIM CLINIC
City	:	APO
State	:	AE
Zip	:	09140
Country	:	DE
Telephone Number	:	011499841
Fax Number	:	834834

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/21/2022

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