Provider Demographics
NPI:1033134457
Name:WARE, MELANIE J (CNM)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:WARE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:J
Other - Last Name:DYAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5853
Mailing Address - Country:US
Mailing Address - Phone:501-376-6694
Mailing Address - Fax:501-376-6695
Practice Address - Street 1:1021 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5853
Practice Address - Country:US
Practice Address - Phone:501-376-6694
Practice Address - Fax:501-376-6695
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM01021176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161448799Medicaid
Q74066Medicare UPIN
AR5A079F528Medicare PIN