MEDICARE: MELISSA LEE WHITNEY

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	851043	NV

General Provider Information

NPI Number	:	1235870973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LEE WHITNEY

Provider Business Mailing Address
First Line	:	7111 STANLEY FREDERICK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6044
Country	:	US
Telephone Number	:	910-478-8412
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 STANLEY FREDERICK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6044
Country	:	US
Telephone Number	:	910-478-8412
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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