Healthcare Provider Details

I. General information

NPI: 1326758517
Provider Name (Legal Business Name): MELISSA SUE JAMESON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W IMPERIAL HWY
BREA CA
92821-3812
US

IV. Provider business mailing address

955 W IMPERIAL HWY STE 201
BREA CA
92821-3812
US

V. Phone/Fax

Practice location:
  • Phone: 714-686-1273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010618
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number675463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: