Provider Demographics
NPI:1003914904
Name:BIRCH, MELANIE L (NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:BIRCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6609
Mailing Address - Country:US
Mailing Address - Phone:330-393-5864
Mailing Address - Fax:330-393-9921
Practice Address - Street 1:1421 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6609
Practice Address - Country:US
Practice Address - Phone:330-393-5864
Practice Address - Fax:330-393-9921
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-07903-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539828Medicaid