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Individual

MRS. MELANIE CHISAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
3800 S NATIONAL AVE STE 510, SPRINGFIELD, MO 65807-5284
(417) 875-3114
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2005007764
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1225136542
MO
05
220024592
MO
Enumeration date
09/20/2006
Last updated
12/27/2018
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