Provider Demographics
NPI:1396450417
Name:PETROSSIAN, MELANIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:PETROSSIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE STE 830
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2132
Mailing Address - Country:US
Mailing Address - Phone:818-390-1777
Mailing Address - Fax:
Practice Address - Street 1:500 E OLIVE AVE STE 830
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2132
Practice Address - Country:US
Practice Address - Phone:818-390-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015115363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care