Healthcare Provider Details

I. General information

NPI: 1700795960
Provider Name (Legal Business Name): MELLANISE MCGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 N 84TH DR
PHOENIX AZ
85037-3739
US

IV. Provider business mailing address

2358 N 84TH DR
PHOENIX AZ
85037-3739
US

V. Phone/Fax

Practice location:
  • Phone: 480-618-7803
  • Fax:
Mailing address:
  • Phone: 928-500-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: