Provider Demographics
NPI:1578961736
Name:RONNEBURG, MELISSA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:RONNEBURG
Suffix:
Gender:F
Credentials:NP
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 535
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95327-0535
Mailing Address - Country:US
Mailing Address - Phone:209-984-4820
Mailing Address - Fax:209-984-4825
Practice Address - Street 1:18144 SECO ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:CA
Practice Address - Zip Code:95327-9498
Practice Address - Country:US
Practice Address - Phone:209-984-4820
Practice Address - Fax:209-984-4825
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily