Provider Demographics
NPI:1205852605
Name:MELSON, LORI (NP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:MELSON
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 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3474
Mailing Address - Fax:805-739-3982
Practice Address - Street 1:220 SOUTH PALISADE DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8902
Practice Address - Country:US
Practice Address - Phone:805-434-5497
Practice Address - Fax:805-354-7102
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5971363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health