Provider Demographics
NPI:1881131985
Name:MELTON, BETHANY MICHELLE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:MELTON
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 1:305 HOMESTEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-3214
Mailing Address - Country:US
Mailing Address - Phone:303-885-0938
Mailing Address - Fax:
Practice Address - Street 1:305 HOMESTEAD PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-3214
Practice Address - Country:US
Practice Address - Phone:303-885-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula