Provider Demographics
NPI:1770397259
Name:ANDERSON, MELANIE FERN (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:FERN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17633 W MARSHALL LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1743
Mailing Address - Country:US
Mailing Address - Phone:623-377-6165
Mailing Address - Fax:
Practice Address - Street 1:14300 W GRANITE VALLEY DR STE E23
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5798
Practice Address - Country:US
Practice Address - Phone:623-975-0500
Practice Address - Fax:623-975-0705
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ252062207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine