Provider Demographics
NPI:1669232831
Name:RESURRECCION, MYLENE MEILANY CO (FNP-C)
Entity type:Individual
Prefix:
First Name:MYLENE MEILANY
Middle Name:CO
Last Name:RESURRECCION
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 1:280 EDWIN WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-3518
Mailing Address - Country:US
Mailing Address - Phone:510-304-3357
Mailing Address - Fax:
Practice Address - Street 1:280 EDWIN WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-3518
Practice Address - Country:US
Practice Address - Phone:510-304-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily