Healthcare Provider Details

I. General information

NPI: 1053439273
Provider Name (Legal Business Name): ELAINE JAUREE MELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N KAWEAH AVE
EXETER CA
93221-1220
US

IV. Provider business mailing address

244 N KAWEAH AVE
EXETER CA
93221-1220
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-3889
  • Fax: 559-592-9317
Mailing address:
  • Phone: 559-592-3889
  • Fax: 559-592-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 11629
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP11629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: