Provider Demographics
NPI:1003162108
Name:NUGENT, MELANIE ANN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:NUGENT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4710
Mailing Address - Country:US
Mailing Address - Phone:602-865-4442
Mailing Address - Fax:602-865-4507
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:602-865-4442
Practice Address - Fax:602-865-4507
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4532363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics