Healthcare Provider Details

I. General information

NPI: 1063366771
Provider Name (Legal Business Name): MELANIE DAWN RICHARDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16791 ALEXANDER AVE
NORTH EDWARDS CA
93523-3525
US

IV. Provider business mailing address

16791 ALEXANDER AVE
NORTH EDWARDS CA
93523-3525
US

V. Phone/Fax

Practice location:
  • Phone: 760-514-6635
  • Fax:
Mailing address:
  • Phone: 760-514-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number835158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: