Healthcare Provider Details

I. General information

NPI: 1275585812
Provider Name (Legal Business Name): MELISSA MESICK METH A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WILLARD AVE
NEWINGTON CT
06111-2631
US

IV. Provider business mailing address

98 BOULDERCREST LN
VERNON CT
06066-5944
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-6709
  • Fax: 860-667-6872
Mailing address:
  • Phone: 860-872-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR29848
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number000803
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: