Provider Demographics
NPI:1598398216
Name:PINO, MELISSA ROSE (CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:PINO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 PROSPECT PL NE STE D 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5287
Mailing Address - Country:US
Mailing Address - Phone:505-369-7200
Mailing Address - Fax:
Practice Address - Street 1:7111 PROSPECT PL NE STE D 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5287
Practice Address - Country:US
Practice Address - Phone:505-369-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAG02200065363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care