Healthcare Provider Details

I. General information

NPI: 1548989650
Provider Name (Legal Business Name): MELISSA CATHERINE ENNIS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CATHERINE BAKER

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E LATHAM AVE STE B
HEMET CA
92543-4423
US

IV. Provider business mailing address

1225 E LATHAM AVE STE B
HEMET CA
92543-4423
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-2800
  • Fax: 951-929-2303
Mailing address:
  • Phone: 951-929-2800
  • Fax: 951-929-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95160974
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95160974
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022314
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: