Basic Information
| Provider Information | |||||||||
| NPI: | 1578582656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLADE MELLO | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 EAST ST | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029202042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191940 | ||||||||
| FaxNumber: | 4013516613 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 EAST ST | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029202042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191940 | ||||||||
| FaxNumber: | 4013516613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/31/2011 | ||||||||
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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 | 363LF0000X | NPP37357 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | MW00114 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.