| NPI | 1477786192 |
|---|---|
| Former Name | MELANIE SUE MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME102774) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 240077) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2014-04-28 |