| NPI | 1891245981 |
|---|---|
| Former Name | MELISSA LYNN FANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 105608) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185033) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP016840) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD AC003394) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R184523) | |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2022-09-06 |