Healthcare Provider Details

I. General information

NPI: 1770851297
Provider Name (Legal Business Name): MELISSA ANN NICHOLAS RN, BSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E GONZALES RD 102
OXNARD CA
93036-3707
US

IV. Provider business mailing address

2220 E GONZALES RD 102
OXNARD CA
93036-3707
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5115
  • Fax:
Mailing address:
  • Phone: 805-981-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number799377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: