MEDICARE: MELISSA MALTHOUSE FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	821235	NV
2	363L00000X	Nurse Practitioner	821235	NV

General Provider Information

NPI Number	:	1316507387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MALTHOUSE FNP-BC

Provider Business Mailing Address
First Line	:	7925 RED BARN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2006
Country	:	US
Telephone Number	:	775-344-8293
Fax Number	:

Provider Business Practice Location Address
First Line	:	7925 RED BARN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2006
Country	:	US
Telephone Number	:	775-344-8293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	03/10/2026

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