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General NPI Number Information
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NPI Number | 1861722621
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Entity Type | Individual
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Provider Name | MELISSA A. MARK CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2001 DWIGHT WAY FL 2
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-5770
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Fax | 510-204-5749
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 510-204-1591
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Fax | 510-204-5749
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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 | NP21279
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP010669
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 21279
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License Number State | CA
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