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NPI Code Detail

MEDICARE: MELISSA ANNE PETERSON RN, MSN, NP

MEDICARE: MELISSA ANNE PETERSON RN, MSN, NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner95000725CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner95000725CA

General Provider Information

NPI Number : 1083028930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANNE PETERSON RN, MSN, NP
Provider Business Mailing Address
First Line : 4650 W SUNSET BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6062
Country : US
Telephone Number : 323-361-4148
Fax Number : 323-361-3668
Provider Business Practice Location Address
First Line : 4650 W SUNSET BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6062
Country : US
Telephone Number : 323-361-4148
Fax Number : 323-361-3668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2014
Last Update Date : 04/13/2026

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