Provider Demographics
NPI:1689715955
Name:NEZTSOSIE, MELANIE (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:NEZTSOSIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:NEZTSOSIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:SAGE MEMORIAL HOSPITAL
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4500
Mailing Address - Fax:
Practice Address - Street 1:ARIZONA HIGHWAY 264 AND HIGHWAY 191 SOUTH
Practice Address - Street 2:SAGE MEMORIAL HOSPITAL
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN118177163W00000X
AZAP5195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse