Healthcare Provider Details

I. General information

NPI: 1912843004
Provider Name (Legal Business Name): MELANI DIANE CORNISH LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

8785 LA MARGARITA WAY
SACRAMENTO CA
95828-5890
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7000
  • Fax:
Mailing address:
  • Phone: 916-533-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number751266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: