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Organization
MGF WELLNESS VISITS LLC
Active
Organization
MGF WELLNESS VISITS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE GAY FORMAN NP (ADULT NURSE PRACTITIONER)
(516) 451-9355
Entity
Organization
Contact information
Practice address
1618 PARK ST, ATLANTIC BEACH, NY 11509-1520
(516) 451-9355
Mailing address
1618 PARK ST, ATLANTIC BEACH, NY 11509-1520
(516) 451-9355
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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