Provider Demographics
NPI:1073086708
Name:O'NEAL, MELINDA NICOLE (CNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:NICOLE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:NICOLE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-1615
Mailing Address - Fax:
Practice Address - Street 1:360 E MONTVUE DR STE 200
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6318
Practice Address - Country:US
Practice Address - Phone:208-381-1615
Practice Address - Fax:208-381-5141
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63781363LF0000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care