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NPI Code Detail

MEDICARE: BROOKE ALENE MELANCON

MEDICARE: BROOKE ALENE MELANCON
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
1363LF0000XFamily Nurse Practitioner206194LA

General Provider Information

NPI Number : 1386204972
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE ALENE MELANCON
Provider Business Mailing Address
First Line : 2840 FLORIDA BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-2721
Country : US
Telephone Number : 225-224-2502
Fax Number :
Provider Business Practice Location Address
First Line : 2840 FLORIDA BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-2721
Country : US
Telephone Number : 225-224-2502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2019
Last Update Date : 08/13/2019

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Directions to “ BROOKE ALENE MELANCON ” Practice Location

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