Provider Demographics
NPI:1902567282
Name:VANDERBURG, MELISSA MAE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAE
Last Name:VANDERBURG
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0001
Mailing Address - Country:US
Mailing Address - Phone:805-339-1122
Mailing Address - Fax:805-339-1128
Practice Address - Street 1:800 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93009-0001
Practice Address - Country:US
Practice Address - Phone:805-339-1122
Practice Address - Fax:805-339-1128
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator