Provider Demographics
NPI:1447236799
Name:MELLO DENNIS, PAMELA LEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LEE
Last Name:MELLO DENNIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-626-6155
Mailing Address - Fax:530-626-6674
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:SUITE 608
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-672-7060
Practice Address - Fax:530-672-7061
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258281163W00000X
CANP1845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50839Medicare UPIN