Healthcare Provider Details

I. General information

NPI: 1689172058
Provider Name (Legal Business Name): MELISSA MARIE LECLAIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA M FAUCHER

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 03/12/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOOD SAMARITAN WOMEN'S HEALTH 830 OAK ST
BROCKTON MA
02301
US

IV. Provider business mailing address

BMCHS PROVIDER ENROLLMENT 960 MASSACHUSETTS AVE FLR 2
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 508-408-6752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN226393
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN226393
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: