Provider Demographics
NPI:1760538805
Name:MELVILLE, TAMARA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:MELVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:4958 N RAVENCREST LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7724
Mailing Address - Country:US
Mailing Address - Phone:801-341-4241
Mailing Address - Fax:
Practice Address - Street 1:1144 W 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7175
Practice Address - Country:US
Practice Address - Phone:801-433-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2757328900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health