Provider Demographics
NPI:1033840699
Name:DAVIS, MELISSA A (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E ALESSANDRO BLVD # 9A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5095
Mailing Address - Country:US
Mailing Address - Phone:774-283-3066
Mailing Address - Fax:
Practice Address - Street 1:191 E ALESSANDRO BLVD # 9A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5095
Practice Address - Country:US
Practice Address - Phone:951-780-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily