Provider Demographics
NPI:1366869638
Name:MELROSE, MELODY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MELROSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E OSBORN RD
Mailing Address - Street 2:SUITE B150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5678
Mailing Address - Country:US
Mailing Address - Phone:602-264-4431
Mailing Address - Fax:602-266-3870
Practice Address - Street 1:1313 E OSBORN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5678
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-266-3870
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ914675Medicaid
AZ914675Medicaid