Provider Demographics
NPI:1083383111
Name:SPOTTS, MELANIE JEAN (APRN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEAN
Last Name:SPOTTS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:JEAN
Other - Last Name:ROSSIGNOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 S JONES BLVD STE 3549
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:720-432-6557
Mailing Address - Fax:725-267-1454
Practice Address - Street 1:304 S JONES BLVD # 3549
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2623
Practice Address - Country:US
Practice Address - Phone:720-432-6557
Practice Address - Fax:725-267-1454
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV841279363L00000X, 363LP2300X
COAPN.10000.91-NP363LP2300X
AZTELE314262363LP2300X
OR10039406363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV841279OtherSTATE LICENSE