Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP03672 | LA |
NPI | 1013243104 |
---|---|
Provider Name | Rebecca Ann Melancon |
First Address | Houma, LA 70360-5004 |
Second Address | Thibodaux, LA 70301-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2009 |
Last Update Date | 12/11/2020 |