Provider Demographics
NPI:1548564040
Name:INGKOM, MELISSA KRISTIN (NP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:KRISTIN
Last Name:INGKOM
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Gender:F
Credentials:NP
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Mailing Address - Street 1:4234 RIVERWALK PARKWAY SUITE 230
Mailing Address - Street 2:PACIFIC PULMONARY MEDICAL GROUP
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505
Mailing Address - Country:US
Mailing Address - Phone:951-781-3672
Mailing Address - Fax:951-781-3605
Practice Address - Street 1:4234 RIVERWALK PARKWAY SUITE 230
Practice Address - Street 2:PACIFIC PULMONARY MEDICAL GROUP
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505
Practice Address - Country:US
Practice Address - Phone:951-781-3672
Practice Address - Fax:951-781-3605
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2015-08-17
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily