MEDICARE: MELANIE RANTA NP-C

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	4704115932	MI

General Provider Information

NPI Number	:	1316990757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE RANTA NP-C

Provider Business Mailing Address
First Line	:	245 STATE ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4328
Country	:	US
Telephone Number	:	616-685-1808
Fax Number	:	616-685-1850

Provider Business Practice Location Address
First Line	:	1471 E BELTLINE AVE NE
Second Line	:	SUITE 201
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-4548
Country	:	US
Telephone Number	:	616-685-8620
Fax Number	:	616-447-7674

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/30/2009

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