Provider Demographics
NPI:1790131373
Name:MEEHAN, MELISSA DIANE (MSN, RN, CNS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:MSN, RN, CNS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DIANE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2681 W CANYON AVE
Mailing Address - Street 2:APT 547
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4736
Mailing Address - Country:US
Mailing Address - Phone:760-846-4098
Mailing Address - Fax:
Practice Address - Street 1:2681 W CANYON AVE
Practice Address - Street 2:APT 547
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4736
Practice Address - Country:US
Practice Address - Phone:760-846-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415908163WM0705X
CA4444364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical