Individual
BRENT ALAN MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
600 HOYT ST, PERU, NE 68421
(402) 872-2390
Mailing address
1908 PARK AVE, PERU, NE 68421-3044
(402) 872-7217
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
400
NE
Other
Enumeration date
02/12/2007
Last updated
07/08/2007
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