=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043835226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA NAGEL FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2020
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1465 CIVIC CT
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-7914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-678-5250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 LONDON CIR
-----------------------------------------------------
City | BENICIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94510-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-924-2744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95138290
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95019033
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------