| NPI | 1346489119 |
|---|---|
| Former Name | MELISSA GALLISON BLACKSTONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 300795) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2014-05-13 |