Provider Demographics
NPI:1659261279
Name:MABUNAY, MELYN JOY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELYN
Middle Name:JOY
Last Name:MABUNAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MELYN
Other - Middle Name:JOY
Other - Last Name:AUTENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 E 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5538
Mailing Address - Country:US
Mailing Address - Phone:219-472-0379
Mailing Address - Fax:
Practice Address - Street 1:757 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5538
Practice Address - Country:US
Practice Address - Phone:219-472-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167189A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily