Provider Demographics
NPI:1619016904
Name:DUECK, MELVIN JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:JAMES
Last Name:DUECK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21213 HAWTHORNE BLVD STE B
Mailing Address - Street 2:#5603
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5522
Mailing Address - Country:US
Mailing Address - Phone:714-515-5558
Mailing Address - Fax:888-807-7965
Practice Address - Street 1:21213 HAWTHORNE BLVD STE B
Practice Address - Street 2:#5603
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5522
Practice Address - Country:US
Practice Address - Phone:714-515-5558
Practice Address - Fax:888-807-7965
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11742OtherNURSE PRACTITIONER LIC #
CA11742OtherNURSE PRACTITIONER LIC #