Healthcare Provider Details

I. General information

NPI: 1891216164
Provider Name (Legal Business Name): MELANIE LOUISE GOODRICH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE LOUISE LEE

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DODGE ST
BEVERLY MA
01915-1705
US

IV. Provider business mailing address

45 TRADERS WAY APT 30113
SALEM MA
01970-1387
US

V. Phone/Fax

Practice location:
  • Phone: 617-865-2749
  • Fax:
Mailing address:
  • Phone: 520-256-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2389822
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10284
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: