MEDICARE: MRS. MELISSA JEAN GRABLE

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	:	1922862051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA JEAN GRABLE

Provider Business Mailing Address
First Line	:	35442 ARROWHEAD LN
Second Line	:
City	:	SQUAW VALLEY
State	:	CA
Zip	:	93675-9683
Country	:	US
Telephone Number	:	559-356-7205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5614 N FRESNO ST STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-6034
Country	:	US
Telephone Number	:	559-356-7205
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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