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General NPI Number Information
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NPI Number | 1164836136
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Entity Type | Individual
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Provider Name | MELISSA LYNN VANDIVER MN-FNP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1936 MAGAZINE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70130-5016
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Country | US
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Telephone | 45-295-5585
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Fax | 985-888-1838
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Provider Business Mailing Address
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Address Line | 119 CHARWOOD DR
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City | PEARL RIVER
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State | LA
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Zip | 70452-3701
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Country | US
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Telephone | 985-960-3634
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Fax | 985-888-1838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP07833
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License Number State | LA
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