MEDICARE: MS. MELISSA CHARISE HORN

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	:	1801490420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA CHARISE HORN

Provider Business Mailing Address
First Line	:	1759 MOUNTAIN AVE
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 POMONA AVE APT 4H
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07112-2330
Country	:	US
Telephone Number	:	908-531-2518
Fax Number	:

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

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	11/24/2020

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