Healthcare Provider Details

I. General information

NPI: 1275200362
Provider Name (Legal Business Name): MERILEE MARIE VANCE RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST STE 2100
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

18035 BROOKHURST ST STE 2100
FOUNTAIN VALLEY CA
92708-6738
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-9090
  • Fax: 714-665-4603
Mailing address:
  • Phone: 657-241-9090
  • Fax: 714-665-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number95122434
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM236340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: