Basic Information
| Provider Information | |||||||||
| NPI: | 1447236799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLO DENNIS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45680 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941450680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306266155 | ||||||||
| FaxNumber: | 5306266674 | ||||||||
| Practice Location | |||||||||
| Address1: | 3581 PALMER DR | ||||||||
| Address2: | SUITE 608 | ||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956828236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306727060 | ||||||||
| FaxNumber: | 5306727061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 258281 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | NP1845 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.