Healthcare Provider Details

I. General information

NPI: 1114196425
Provider Name (Legal Business Name): MELISA MARIE HILL RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST 2PICU
ORANGE CA
92868-3835
US

IV. Provider business mailing address

12200 MONTECITO RD UNIT B106
SEAL BEACH CA
90740-2651
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-8421
  • Fax:
Mailing address:
  • Phone: 562-818-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number607923
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: