Provider Demographics
NPI:1194378588
Name:MELAGO, BREANN J (MSN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BREANN
Middle Name:J
Last Name:MELAGO
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4117
Mailing Address - Country:US
Mailing Address - Phone:330-979-1510
Mailing Address - Fax:
Practice Address - Street 1:1875 TAFT AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4117
Practice Address - Country:US
Practice Address - Phone:330-979-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF07191505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine