MEDICARE: MELANIE DEMOISE RN, BSN

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	163WS0200X	School Registered Nurse	00073474	SC

General Provider Information

NPI Number	:	1477927366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE DEMOISE RN, BSN

Provider Business Mailing Address
First Line	:	900 WOODSIDE AVE
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WOODSIDE AVE
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4221
Country	:	US
Telephone Number	:	864-248-0646
Fax Number	:

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

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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