MEDICARE: MELISSA J ALWERT RN BSN CCM

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	163WC0400X	Case Management Registered Nurse	R0064862	OK

General Provider Information

NPI Number	:	1568227288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA J ALWERT RN BSN CCM

Provider Business Mailing Address
First Line	:	9508 N 109TH EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-4390
Country	:	US
Telephone Number	:	918-519-0744
Fax Number	:	770-723-8860

Provider Business Practice Location Address
First Line	:	9508 N 109TH EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-4390
Country	:	US
Telephone Number	:	918-519-0744
Fax Number	:	770-723-8860

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

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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