Provider Demographics
NPI:1861738023
Name:MANUEL, MELISSA KATHLEEN CANCIO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHLEEN CANCIO
Last Name:MANUEL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHLEEN
Other - Last Name:CANCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5288 COLLECT LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4273
Mailing Address - Country:US
Mailing Address - Phone:707-803-2930
Mailing Address - Fax:
Practice Address - Street 1:2449 PACHECO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2019
Practice Address - Country:US
Practice Address - Phone:916-907-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95118610163W00000X
CA1861738023363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse