Healthcare Provider Details

I. General information

NPI: 1679166805
Provider Name (Legal Business Name): MELANIE ANN LAUB PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 W CHANDLER BLVD BLDG A
CHANDLER AZ
85224-6237
US

IV. Provider business mailing address

8818 E ODESSA ST
MESA AZ
85207-9100
US

V. Phone/Fax

Practice location:
  • Phone: 480-786-8200
  • Fax: 480-857-3005
Mailing address:
  • Phone: 435-773-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number254311
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: