Provider Demographics
NPI:1962772335
Name:YURKOVICH, MELANIE ANN (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:YURKOVICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 MOUNTAIN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9707
Mailing Address - Country:US
Mailing Address - Phone:209-754-3521
Mailing Address - Fax:
Practice Address - Street 1:1919 VISTA DEL LAGO
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9294
Practice Address - Country:US
Practice Address - Phone:209-772-9538
Practice Address - Fax:209-772-0312
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily