Provider Demographics
NPI:1588633721
Name:BAINBRIDGE, MELANIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4785 S DURANGO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8167
Mailing Address - Country:US
Mailing Address - Phone:702-889-8444
Mailing Address - Fax:702-889-8454
Practice Address - Street 1:4785 S DURANGO DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8167
Practice Address - Country:US
Practice Address - Phone:702-889-8444
Practice Address - Fax:702-889-8454
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19683363LP0200X
NV814650363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics