Healthcare Provider Details

I. General information

NPI: 1609799857
Provider Name (Legal Business Name): MELISSA LAWRENCE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 E MAIN ST STE 210
SANTA MARIA CA
93454-4836
US

IV. Provider business mailing address

1032 PARKVIEW PL
SAN LUIS OBISPO CA
93405-1572
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-3678
  • Fax:
Mailing address:
  • Phone: 510-847-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95040859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: