Provider Demographics
NPI:1578582656
Name:BLADE MELLO, MICHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BLADE MELLO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2042
Mailing Address - Country:US
Mailing Address - Phone:401-519-1940
Mailing Address - Fax:401-351-6613
Practice Address - Street 1:263 EAST ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2042
Practice Address - Country:US
Practice Address - Phone:401-519-1940
Practice Address - Fax:401-351-6613
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37357363LF0000X
RIMW00114367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily