Provider Demographics
NPI:1528360369
Name:WARREN, MELODY WONG (NP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:WONG
Last Name:WARREN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:BLOUNT MEMORIAL BUSINESS HEALTH
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-977-5535
Mailing Address - Fax:865-977-4612
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:BLOUNT MEMORIAL BUSINESS HEALTH
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-977-5535
Practice Address - Fax:865-977-4612
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000177541163W00000X
TNAPN0000015217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse