Provider Demographics
NPI:1356768493
Name:AUSTIN, MELODY DAWN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:DAWN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:DAWN
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20449 N LAKE PLEASANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2707
Mailing Address - Country:US
Mailing Address - Phone:623-322-0099
Mailing Address - Fax:623-322-0096
Practice Address - Street 1:20449 N LAKE PLEASANT RD STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2707
Practice Address - Country:US
Practice Address - Phone:623-322-0099
Practice Address - Fax:623-322-0096
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN138612163WC1500X
AZAP5530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health