MEDICARE: MRS. ELIZABETH NANCE MELANCON MSN, FNP-C

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	363LF0000X	Family Nurse Practitioner	RN 079737 AP04815	LA

General Provider Information

NPI Number	:	1841225596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH NANCE MELANCON MSN, FNP-C

Provider Business Mailing Address
First Line	:	13201 HIGHWAY 73 STE 102
Second Line	:
City	:	GEISMAR
State	:	LA
Zip	:	70734-3091
Country	:	US
Telephone Number	:	225-673-2088
Fax Number	:	225-673-2080

Provider Business Practice Location Address
First Line	:	13201 HIGHWAY 73 STE 102
Second Line	:
City	:	GEISMAR
State	:	LA
Zip	:	70734-3091
Country	:	US
Telephone Number	:	225-673-2088
Fax Number	:	225-673-2080

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/18/2016

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