Provider Demographics
NPI:1194300152
Name:MELLUM, NATHANAEL DUANE (PMHNP)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:DUANE
Last Name:MELLUM
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 COURT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1710
Mailing Address - Country:US
Mailing Address - Phone:775-980-2022
Mailing Address - Fax:775-980-2022
Practice Address - Street 1:515 COURT ST LOWR FLOOR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1710
Practice Address - Country:US
Practice Address - Phone:775-980-2022
Practice Address - Fax:775-980-2022
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838969363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty