Healthcare Provider Details

I. General information

NPI: 1437830668
Provider Name (Legal Business Name): MELANIE MANUEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 LOSEE RD
NORTH LAS VEGAS NV
89081-2523
US

IV. Provider business mailing address

3089 AZURE BAY ST
LAS VEGAS NV
89117-2572
US

V. Phone/Fax

Practice location:
  • Phone: 702-552-1818
  • Fax: 702-968-8637
Mailing address:
  • Phone: 702-580-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number864101
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: