Healthcare Provider Details

I. General information

NPI: 1770397259
Provider Name (Legal Business Name): MELANIE FERN ANDERSON AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 W GRANITE VALLEY DR STE E23
SUN CITY WEST AZ
85375-5798
US

IV. Provider business mailing address

14300 W GRANITE VALLEY DR STE E23
SUN CITY WEST AZ
85375-5798
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-0500
  • Fax: 623-975-0705
Mailing address:
  • Phone: 623-975-0500
  • Fax: 623-975-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number252062
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number252062
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number252062
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: