Provider Demographics
NPI:1780748194
Name:GILL, MELODIE G (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:G
Last Name:GILL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PLACER ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1170
Mailing Address - Country:US
Mailing Address - Phone:530-346-5710
Mailing Address - Fax:530-245-0638
Practice Address - Street 1:4215 FRONT ST
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9430
Practice Address - Country:US
Practice Address - Phone:530-276-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002268A363LF0000X
CA95015089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200846030Medicaid
INM400026193Medicare PIN