1114131422

Everything you always wanted to know about MRS. FREDERICK J MELYSSA but were afraid to ask.

MRS. FREDERICK J MELYSSA

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Provider Prefix Provider Last Name Provider Middle Name Provider First Name
MRS. FREDERICK J MELYSSA
Gender:
Female
Enumeration date:
2007-05-09
Last update date:
2007-07-08
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
1041C0700X Clinical MO 005968 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 6362077878
Practice Location Address Telephone Number 6362077878
Mailing Address Fax Number 6362077869
Practice Location Address Fax Number 6362077869

Addresses

Type Address City State Postal Country
Mailing Address 396 BENBOW CT BALLWIN MO 63011 MO
Practice Location Address 396 BENBOW CT BALLWIN MO 63011 MO