Provider Demographics
NPI:1679564140
Name:MANRIQUES, MELISSA (BC, FNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MANRIQUES
Suffix:
Gender:F
Credentials:BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LIND AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0934
Mailing Address - Country:US
Mailing Address - Phone:559-322-7729
Mailing Address - Fax:
Practice Address - Street 1:1095 E WARNER AVE
Practice Address - Street 2:# 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4043
Practice Address - Country:US
Practice Address - Phone:559-435-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14171363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACF060ZMedicare PIN