Healthcare Provider Details

I. General information

NPI: 1639377518
Provider Name (Legal Business Name): MELISSA JELIN CLAUDIO GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax: 602-462-1186
Mailing address:
  • Phone: 602-462-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP2719
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: