Provider Demographics
NPI:1982762068
Name:MELROSE, JANE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:MELROSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAGLES REST RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7624
Mailing Address - Country:US
Mailing Address - Phone:802-985-5833
Mailing Address - Fax:802-985-2385
Practice Address - Street 1:107 EAGLES REST RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7624
Practice Address - Country:US
Practice Address - Phone:802-985-5833
Practice Address - Fax:802-985-2385
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000186171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist