Provider Demographics
NPI:1790066686
Name:MELBURG, GRETCHEN (FNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MELBURG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KNOLLCREST DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0104
Mailing Address - Country:US
Mailing Address - Phone:530-768-9490
Mailing Address - Fax:530-653-2150
Practice Address - Street 1:760 CYPRESS AVE STE 110
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2743
Practice Address - Country:US
Practice Address - Phone:530-768-9490
Practice Address - Fax:650-653-2150
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790066686Medicaid
CA1790066686Medicaid