Provider Demographics
NPI:1659550747
Name:PORTER, MELINDA JILL (RN, NNP-BC, CNS)
Entity Type:Individual
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First Name:MELINDA
Middle Name:JILL
Last Name:PORTER
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Gender:F
Credentials:RN, NNP-BC, CNS
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Mailing Address - Street 1:2500 MERCED STREET
Mailing Address - Street 2:3RD FLOOR, NICU
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:510-454-3546
Mailing Address - Fax:
Practice Address - Street 1:2500 MERCED STREET
Practice Address - Street 2:3RD FLOOR, NICU
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2015-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CARN536076163W00000X
CA13535363LN0005X
CA1689364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care