MEDICARE: MS. MELANIE ANNE DOTY NP MSN

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	163W00000X	Registered Nurse	RN 307291	CA
2	363LF0000X	Family Nurse Practitioner	NPC #8930	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NPF#8930	OTHER	CA	FURNISHING NUMBER

General Provider Information

NPI Number	:	1790880300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELANIE ANNE DOTY NP MSN

Provider Business Mailing Address
First Line	:	401 BICENTENNIAL WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2149
Country	:	US
Telephone Number	:	707-571-3188
Fax Number	:	707-571-4337

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH CENT
Second Line	:	1156 HIGH STREET
City	:	SANTA ROSA
State	:	CA
Zip	:	95064
Country	:	US
Telephone Number	:	831-459-2211
Fax Number	:	831-459-3546

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/12/2025

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