Provider Demographics
NPI:1518424704
Name:KIRVEN, MELANIE SHARI
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SHARI
Last Name:KIRVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 DUERO PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4994
Mailing Address - Country:US
Mailing Address - Phone:505-261-1746
Mailing Address - Fax:
Practice Address - Street 1:4020 PEGGY RD SE STE F
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1035
Practice Address - Country:US
Practice Address - Phone:505-261-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC0370741744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management