Provider Demographics
NPI:1528428653
Name:CARDINE, MELISSA (MSN, RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARDINE
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 E SIERRA MADRE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1516
Mailing Address - Country:US
Mailing Address - Phone:602-499-4584
Mailing Address - Fax:
Practice Address - Street 1:2158 E SIERRA MADRE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1516
Practice Address - Country:US
Practice Address - Phone:602-499-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN000099121163W00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163W00000XNursing Service ProvidersRegistered Nurse