Provider Demographics
NPI:1861899312
Name:CALVARESE, MELANIE DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:CALVARESE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8055
Mailing Address - Country:US
Mailing Address - Phone:352-281-2795
Mailing Address - Fax:
Practice Address - Street 1:671 ALEXIAN WAY
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2175
Practice Address - Country:US
Practice Address - Phone:615-673-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19468363LF0000X
GARN235059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily