Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20172682 | OH |
NPI | 1003330499 |
---|---|
Provider Name | Mrs. Melanie Marie Klockner |
First Address | Akron, OH 44308-1063 |
Second Address | Austintown, OH 44515-1820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 03/03/2021 |