MEDICARE: MELISSA E. GARDNER RNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	193437	CA

General Provider Information

NPI Number	:	1740275700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E. GARDNER RNP

Provider Business Mailing Address
First Line	:	6600 BRUCEVILLE RD
Second Line	:	OBGYN STATION A
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4671
Country	:	US
Telephone Number	:	916-688-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 BRUCEVILLE RD
Second Line	:	OBGYN STATION A
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4671
Country	:	US
Telephone Number	:	916-688-2282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/09/2007

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