Provider Demographics
NPI:1144572876
Name:DATU, MELISSA STEPHANIE (APN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:STEPHANIE
Last Name:DATU
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:3230 BEARD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3673
Mailing Address - Country:US
Mailing Address - Phone:707-253-7005
Mailing Address - Fax:707-253-7271
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-253-7005
Practice Address - Fax:707-253-7271
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.009318363LA2200X, 363LG0600X
CANP95003243363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology