Provider Demographics
NPI:1912385055
Name:MELTON, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:CA
Mailing Address - Zip Code:93621-0546
Mailing Address - Country:US
Mailing Address - Phone:559-338-3145
Mailing Address - Fax:
Practice Address - Street 1:49673 HIGH OAKS LN
Practice Address - Street 2:
Practice Address - City:SQUAW VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93675-9658
Practice Address - Country:US
Practice Address - Phone:559-338-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404195163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health