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General NPI Number Information
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NPI Number | 1780748194
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Entity Type | Individual
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Provider Name | MELODIE G. GILL FNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 4215 FRONT ST
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City | SHASTA LAKE
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State | CA
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Zip | 96019-9430
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Country | US
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Telephone | 530-276-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 PLACER ST
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City | REDDING
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State | CA
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Zip | 96001-1170
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Country | US
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Telephone | 530-346-5710
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Fax | 530-245-0638
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71002268A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015089
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License Number State | CA
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