MEDICARE: MYLENE MEILANY CO RESURRECCION FNP-C

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	95028988	CA

General Provider Information

NPI Number	:	1669232831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLENE MEILANY CO RESURRECCION FNP-C

Provider Business Mailing Address
First Line	:	280 EDWIN WAY
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-3518
Country	:	US
Telephone Number	:	510-304-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 EDWIN WAY
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-3518
Country	:	US
Telephone Number	:	510-304-3357
Fax Number	:

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

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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Directions to “ MYLENE MEILANY CO RESURRECCION FNP-C” Practice Location

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