MEDICARE: MELISSA LYNN FOURIE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1255295150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN FOURIE

Provider Business Mailing Address
First Line	:	1690 S SAN TAN VILLAGE PKWY APT 3083
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-9800
Country	:	US
Telephone Number	:	480-771-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 N ALMA SCHOOL RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-4363
Country	:	US
Telephone Number	:	480-571-5541
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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