MEDICARE: MELODY ANN KISOR

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	374J00000X	Doula

General Provider Information

NPI Number	:	1558628610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY ANN KISOR

Provider Business Mailing Address
First Line	:	3271 S STAFFORD ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2014
Country	:	US
Telephone Number	:	703-217-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	3271 S STAFFORD ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2014
Country	:	US
Telephone Number	:	703-217-8733
Fax Number	:

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

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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Directions to “ MELODY ANN KISOR ” Practice Location

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