Provider Demographics
NPI:1780308668
Name:STATTON, MELISSA (NP-C, MSN, RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STATTON
Suffix:
Gender:F
Credentials:NP-C, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2639
Mailing Address - Country:US
Mailing Address - Phone:805-544-2478
Mailing Address - Fax:
Practice Address - Street 1:705 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2639
Practice Address - Country:US
Practice Address - Phone:805-544-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty