Individual
MELISSA JANE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3917 WEST RD, LOS ALAMOS, NM 87544-2275
(505) 661-9230
Mailing address
7029 CAMINO ROJO, SANTA FE, NM 87507-3533
(254) 760-3832
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
CNP-03454
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0292880-02
—
TX
01
—
500008494
RR/MEDICARE
TX
01
—
82N617
BLUE SHIELD
TX
Enumeration date
04/07/2006
Last updated
01/05/2024
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