Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP4532 | AZ |
NPI | 1003162108 |
---|---|
Provider Name | Mrs. Melanie Ann Nugent |
First Address | Glendale, AZ 85306-4710 |
Second Address | Glendale, AZ 85306-4710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2012 |
Last Update Date | 06/03/2018 |