Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 88J1791E | ZZ |
Y | 176B00000X | Midwife | TMW6 | FL |
NPI | 1114297264 |
---|---|
Provider Name | Melanie Jane Fielding |
First Address | Lithia, FL 33547 |
Second Address | Lithia, FL 33547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 06/01/2012 |