Provider Demographics
NPI:1053439273
Name:MELLO, ELAINE JAUREE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:JAUREE
Last Name:MELLO
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 1:244 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1220
Mailing Address - Country:US
Mailing Address - Phone:559-592-3889
Mailing Address - Fax:559-592-9317
Practice Address - Street 1:244 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1220
Practice Address - Country:US
Practice Address - Phone:559-592-3889
Practice Address - Fax:559-592-9317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 11629363LF0000X
CANP11629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily