Healthcare Provider Details

I. General information

NPI: 1730737602
Provider Name (Legal Business Name): MELANIE MATTHEWS RN, BSN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

333 LONGWOOD AVE
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-3046
  • Fax:
Mailing address:
  • Phone: 857-218-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN274157
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: