Individual
MELONIE I BLANCANEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
TSESHOOTSOOI MEDICAL CENTER, CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8587
Mailing address
PO BOX 589, FORT DEFIANCE, AZ 86504-0589
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
121575
AK
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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