Healthcare Provider Details

I. General information

NPI: 1588164560
Provider Name (Legal Business Name): MELISSA ANNE MERTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 08/21/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41837 SIERRA DRIVE
THREE RIVERS CA
93271
US

IV. Provider business mailing address

44778 MINERAL KING RD
THREE RIVERS CA
93271-9712
US

V. Phone/Fax

Practice location:
  • Phone: 559-462-5030
  • Fax: 559-245-0091
Mailing address:
  • Phone: 310-923-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: