Provider Demographics
NPI:1205040722
Name:MELANCON, ELIZABETH (CPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MELANCON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MELANCON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM
Mailing Address - Street 1:1255 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1546
Mailing Address - Country:US
Mailing Address - Phone:702-672-1424
Mailing Address - Fax:702-731-5356
Practice Address - Street 1:1255 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1546
Practice Address - Country:US
Practice Address - Phone:702-672-1424
Practice Address - Fax:702-731-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNONE176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife