Provider Demographics
NPI:1992849947
Name:MITCHEL, MELODY G (CPNP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:G
Last Name:MITCHEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:KAY
Other - Last Name:GIRDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:23321 EL TORO RD
Mailing Address - Street 2:SOCPA
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4825
Mailing Address - Country:US
Mailing Address - Phone:949-770-0711
Mailing Address - Fax:949-770-2941
Practice Address - Street 1:23321 EL TORO RD STE G
Practice Address - Street 2:SOCPA
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4825
Practice Address - Country:US
Practice Address - Phone:949-770-0513
Practice Address - Fax:949-770-2941
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6754363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics