MEDICARE: LORI MELANCON

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	374700000X	Technician

General Provider Information

NPI Number	:	1770341778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MELANCON

Provider Business Mailing Address
First Line	:	704 FOLIAGE CT
Second Line	:
City	:	MADISONVILLE
State	:	LA
Zip	:	70447-3616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 W CAUSEWAY APPROACH
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3036
Country	:	US
Telephone Number	:	504-234-2308
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/13/2024

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Directions to “ LORI MELANCON ” Practice Location

Language	Start Address	Practice Location

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