Healthcare Provider Details

I. General information

NPI: 1578158887
Provider Name (Legal Business Name): MELINDA BECKHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH ST STE 1248
SACRAMENTO CA
95817-1514
US

IV. Provider business mailing address

2279 45TH ST STE 1248
SACRAMENTO CA
95817-1514
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5038
  • Fax: 916-734-0980
Mailing address:
  • Phone: 916-734-5038
  • Fax: 916-734-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN449945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: