Provider Demographics
NPI:1104306026
Name:MORALES, MELISSA ILENE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ILENE
Last Name:MORALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 E BIRCHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3559
Mailing Address - Country:US
Mailing Address - Phone:520-840-1888
Mailing Address - Fax:
Practice Address - Street 1:4831 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3681
Practice Address - Country:US
Practice Address - Phone:602-424-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty