Provider Demographics
NPI:1861130130
Name:CHAN, MELISSA JANE (APRN-PNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:CHAN
Suffix:
Gender:F
Credentials:APRN-PNP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9727 ELK GROVE FLORIN RD STE 250
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2290
Practice Address - Country:US
Practice Address - Phone:916-686-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1075010363LP0200X
CA95034583363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1075010OtherSTATE LICENSE