Individual
MRS. JENNIFER L MELILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
6275 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2851
(757) 961-0606
(757) 233-8499
Mailing address
6275 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2851
(757) 961-0606
(757) 233-8499
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001160085
VA
363LF0000X
Family Nurse Practitioner
0024169372
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024169372
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629139878
—
VA
Enumeration date
12/12/2006
Last updated
03/27/2019
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