1114145661 NPI number — MRS. JUDITH ANN MELTON CPM, LM

Table of content: MRS. JUDITH ANN MELTON CPM, LM (NPI 1114145661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114145661 NPI number — MRS. JUDITH ANN MELTON CPM, LM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELTON
Provider First Name:
JUDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPM, LM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114145661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 E MCDOWELL RD STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85008-4438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-784-7396
Provider Business Mailing Address Fax Number:
480-668-1948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 W UNIVERSITY DR STE 107F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-784-7396
Provider Business Practice Location Address Fax Number:
480-668-1948
Provider Enumeration Date:
04/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  AZ 145 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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