Petchak, Melanie G.
Petchak, Melanie G. is an sole proprietor health care provider with primary practice located at 7611 Saint Vincent Ave , Shreveport LA 71106-4231. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / School, which is considered as her primary health care specialty. Petchak, Melanie G. can be contacted via phone (318) 861-1671.Contact Information
Primary practice address
7611 Saint Vincent Ave
Shreveport LA 71106-4231
Phone: (318) 861-1671
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / School | 363LS0200X | 03820 | Louisiana |
Profile Details
| NPI number | 1336363845 |
|---|---|
| LBN Legal business name | Petchak, Melanie G. |
| Credentials | NP-BC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 13th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336363845 | NPPES |
| Louisiana | MEDICAID | 1166430 |
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