Basic Information
| Provider Information | |||||||||
| NPI: | 1174169494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELVILLE | ||||||||
| FirstName: | ALIX | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | AGACNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MELVILLE | ||||||||
| OtherFirstName: | ALIX | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherCredential: | BSN, RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5921 WESTLAKE BLVD NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447181159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307152329 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK WEST BLVD STE 330 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443204226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308355533 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2019 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | APRN.CNP.025811 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.