Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | COA-07903-NP | OH |
NPI | 1003914904 |
---|---|
Provider Name | Melanie L Birch |
First Address | Warren, OH 44483-6609 |
Second Address | Warren, OH 44483-6609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 26/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2539828 | (05) | OH |