Provider Demographics
NPI:1194550111
Name:MELANIE JO DRAKE MD PLLC
Entity type:Organization
Organization Name:MELANIE JO DRAKE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-722-0899
Mailing Address - Street 1:1116 S VISTA AVE PMB 235
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-722-0899
Mailing Address - Fax:208-205-8031
Practice Address - Street 1:3350 AMERICANA TERRACE
Practice Address - Street 2:SUITE 360-C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-722-0899
Practice Address - Fax:208-205-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty