MEDICARE: MELISSA JOHNSON RN

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	RN137130	AZ

General Provider Information

NPI Number	:	1720450307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JOHNSON RN

Provider Business Mailing Address
First Line	:	4836 E WILLIAMS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4836 E WILLIAMS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6169
Country	:	US
Telephone Number	:	480-502-2273
Fax Number	:

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

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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