Healthcare Provider Details

I. General information

NPI: 1073086708
Provider Name (Legal Business Name): MELINDA NICOLE O'NEAL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA NICOLE TAYLOR CNP

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E MONTVUE DR STE 200
MERIDIAN ID
83642-6318
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-1615
  • Fax: 208-381-5141
Mailing address:
  • Phone: 208-381-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63781
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number63781
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: