Provider Demographics
NPI:1588164560
Name:MERTZ, MELISSA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MERTZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44778 MINERAL KING RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:CA
Mailing Address - Zip Code:93271-9712
Mailing Address - Country:US
Mailing Address - Phone:310-923-4392
Mailing Address - Fax:
Practice Address - Street 1:41837 SIERRA DRIVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271
Practice Address - Country:US
Practice Address - Phone:559-462-5030
Practice Address - Fax:559-245-0091
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily