Provider Demographics
NPI:1477755692
Name:JENNINGS, MELINDA (RN-C, NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN-C, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-452-7199
Mailing Address - Fax:
Practice Address - Street 1:24411 HEALTH CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-452-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17015363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health