Provider Demographics
NPI:1518966001
Name:MELTON, TONYA M (APRN-BC, FNP)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:MELTON
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Gender:F
Credentials:APRN-BC, FNP
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Mailing Address - Street 1:2425 TUXEDO ST STE 126
Mailing Address - Street 2:ST JOHN PROVIDENCE HEALTH CENTER IN CENTRAL HIGH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1222
Mailing Address - Country:US
Mailing Address - Phone:313-865-0576
Mailing Address - Fax:313-865-0840
Practice Address - Street 1:2425 TUXEDO ST STE 126
Practice Address - Street 2:ST JOHN PROVIDENCE HEALTH CENTER IN CENTRAL HIGH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1222
Practice Address - Country:US
Practice Address - Phone:313-865-0576
Practice Address - Fax:313-865-0840
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-10-31
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Provider Licenses
StateLicense IDTaxonomies
MI4704234173363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily