Provider Demographics
NPI:1306396361
Name:WILMARTH, MELISSA LAREE (CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAREE
Last Name:WILMARTH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7394
Mailing Address - Country:US
Mailing Address - Phone:910-907-8333
Mailing Address - Fax:
Practice Address - Street 1:100 WILLOW PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6206
Practice Address - Country:US
Practice Address - Phone:559-627-9284
Practice Address - Fax:559-713-0965
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067850Medicaid
CAZZZ47930ZMedicare PIN