Provider Demographics
NPI:1316004302
Name:BROWN, MELISSA HEATHER II (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:HEATHER
Last Name:BROWN
Suffix:II
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KENNETH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2455
Mailing Address - Country:US
Mailing Address - Phone:831-426-0430
Mailing Address - Fax:
Practice Address - Street 1:115 KENNETH ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2455
Practice Address - Country:US
Practice Address - Phone:831-426-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539734163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS004480OtherPEDIATRIC RN