Provider Demographics
NPI:1952337800
Name:FROST, MELISSA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W CARROLL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4208
Mailing Address - Country:US
Mailing Address - Phone:626-600-8543
Mailing Address - Fax:626-228-2226
Practice Address - Street 1:415 W CARROLL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-600-8543
Practice Address - Fax:626-228-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491644163WP0808X
CA13697363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ51393Medicare UPIN