Provider Demographics
NPI:1265418529
Name:GASTON, MELANIE DAWN (CFNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:GASTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 E WILDS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9712
Mailing Address - Country:US
Mailing Address - Phone:228-596-6792
Mailing Address - Fax:
Practice Address - Street 1:15631 N ORACLE RD
Practice Address - Street 2:SUITE 141
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-8691
Practice Address - Country:US
Practice Address - Phone:520-825-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3320363LF0000X
MSR860324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500001838Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MSQ44128Medicare UPIN