Individual
STACY ELDON MELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
635 INNOVATION DR STE 300, RENO, NV 89511-2215
(775) 329-6241
(775) 329-4921
Mailing address
635 INNOVATION DR STE 300, RENO, NV 89511-2215
(775) 329-6241
(775) 329-4921
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
7499
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-16628
—
NV
Enumeration date
11/01/2006
Last updated
04/12/2024
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