Individual
MRS. MELISSA MARIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
37 S 2ND E, REXBURG, ID 83440-1906
(208) 356-0234
Mailing address
330 CIRCLE DR, RIGBY, ID 83442-1375
(916) 204-7056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
59333
ID
363LF0000X
Family Nurse Practitioner
Primary
59333
ID
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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