Provider Demographics
NPI:1275379968
Name:SAPP, MELAYNIA (PMHNP)
Entity type:Individual
Prefix:
First Name:MELAYNIA
Middle Name:
Last Name:SAPP
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 E SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7719
Mailing Address - Country:US
Mailing Address - Phone:262-470-6108
Mailing Address - Fax:
Practice Address - Street 1:3305 E SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-7719
Practice Address - Country:US
Practice Address - Phone:262-470-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62272163WG0000X
ID2071150363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice