MEDICARE: DR. MELISSA LYNN ST. GERMAIN MD

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	208000000X	Pediatrics Physician	5471	NE

General Provider Information

NPI Number	:	1710105440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LYNN ST. GERMAIN MD

Provider Business Mailing Address
First Line	:	982185 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-2185
Country	:	US
Telephone Number	:	402-559-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	982185 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-2185
Country	:	US
Telephone Number	:	402-559-5380
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/24/2012

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