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General NPI Number Information
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NPI Number | 1457816050
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Entity Type | Individual
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Provider Name | MELANIE RENEE ELLIS APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 79-1019 HAUKAPILA ST
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City | KEALAKEKUA
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State | HI
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Zip | 96750-7920
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Country | US
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Telephone | 808-322-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 87-368 KAOHE MAUKA PL
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City | CAPTAIN COOK
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State | HI
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Zip | 96704-8745
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Country | US
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Telephone | 808-647-4942
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11001166
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP023865
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4316
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License Number State | HI
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