Healthcare Provider Details

I. General information

NPI: 1548907918
Provider Name (Legal Business Name): JAMES MELICK REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 CHESTNUT ST APT 20
SAN FRANCISCO CA
94109-1047
US

IV. Provider business mailing address

1229 CHESTNUT ST APT 20
SAN FRANCISCO CA
94109-1047
US

V. Phone/Fax

Practice location:
  • Phone: 415-770-5701
  • Fax:
Mailing address:
  • Phone: 415-770-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number95067545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: