Provider Demographics
NPI:1750484929
Name:WICE, MELANIE S (NP RN CNM)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:S
Last Name:WICE
Suffix:
Gender:F
Credentials:NP RN CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5 BON AIR RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1143
Mailing Address - Country:US
Mailing Address - Phone:415-945-2114
Mailing Address - Fax:415-924-2021
Practice Address - Street 1:5 BON AIR RD
Practice Address - Street 2:SUITE 217
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1143
Practice Address - Country:US
Practice Address - Phone:415-945-2114
Practice Address - Fax:415-924-2021
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA428287163WW0101X
CA7152363LW0102X
CA937367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health