Healthcare Provider Details

I. General information

NPI: 1073919296
Provider Name (Legal Business Name): ELIZABETH ANNE MELTON APRN, FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PYRAMID WAY STE 206
SPARKS NV
89431-4470
US

IV. Provider business mailing address

5880 PELHAM DR
RENO NV
89502-9730
US

V. Phone/Fax

Practice location:
  • Phone: 775-771-1390
  • Fax: 602-354-9272
Mailing address:
  • Phone: 775-771-1390
  • Fax: 602-354-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number831699
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN118512
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number831699
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN31731
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: