MEDICARE: MELISSA MATHERN NP

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	363L00000X	Nurse Practitioner	APN.0995659-NP	CO

General Provider Information

NPI Number	:	1255944922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MATHERN NP

Provider Business Mailing Address
First Line	:	7818 S HILL CIR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4320
Country	:	US
Telephone Number	:	720-425-2089
Fax Number	:

Provider Business Practice Location Address
First Line	:	7818 S HILL CIR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4320
Country	:	US
Telephone Number	:	720-425-2089
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	07/29/2021

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