Doctor Name: | GRACE MARIE MELLEN |
NPI Number: | 1184010852 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | R.N. / N.P. |
License Number: | AP7444 |
Business Practice Address: | 10585 N Tatum Blvd Suite D130 Paradise Valley, AZ - 852531073 |
Business Phone Number: | 6029977263 |
Business Fax Number: | 6029444553 |
Mailing Address: | 112 E. Mcdowell Rd, PHOENIX |
State: | AZ |
Postal Code: | 850062611 |
Phone Number: | 6022584951 |
Fax Number: | 6023401853 |
NPI Enumeration Date: | 04/09/2015 |
NPI Last Update Date: | 04/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | AP7444 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |