Provider Demographics
NPI:1679382477
Name:JOHNSON, MELANIE ANNE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 WARD RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1925
Mailing Address - Country:US
Mailing Address - Phone:720-724-6813
Mailing Address - Fax:
Practice Address - Street 1:5181 WARD RD UNIT 206
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1925
Practice Address - Country:US
Practice Address - Phone:720-724-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program