Provider Demographics
NPI:1306275581
Name:REICHENBACH, MELISSA KAY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:REICHENBACH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W. OSBORN RD
Mailing Address - Street 2:STE. 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3896
Mailing Address - Country:US
Mailing Address - Phone:602-889-9401
Mailing Address - Fax:602-889-9404
Practice Address - Street 1:444 W. OSBORN RD
Practice Address - Street 2:STE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3896
Practice Address - Country:US
Practice Address - Phone:602-889-9401
Practice Address - Fax:602-889-9404
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3614363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care