Provider Demographics
NPI:1336722537
Name:ACON, MELANIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ACON
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 1:1807 FINLEY DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-1642
Mailing Address - Country:US
Mailing Address - Phone:703-973-1066
Mailing Address - Fax:
Practice Address - Street 1:1807 FINLEY DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1642
Practice Address - Country:US
Practice Address - Phone:703-973-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-302261174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-302261OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS (IBLCE)