Provider Demographics
NPI:1063744357
Name:SIDA, MELANIE RUTH (RN, CPNP)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:RUTH
Last Name:SIDA
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9544 NEWPORT PLUM CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2806
Mailing Address - Country:US
Mailing Address - Phone:720-450-6021
Mailing Address - Fax:
Practice Address - Street 1:9544 NEWPORT PLUM CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2806
Practice Address - Country:US
Practice Address - Phone:720-450-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0003861-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO111251OtherCOLORADO NURSING LICENSE