Healthcare Provider Details

I. General information

NPI: 1952930356
Provider Name (Legal Business Name): MELANIE DAWN HAYWARD RN216817
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TISBURY LN
JEFFERSON MA
01522-1176
US

IV. Provider business mailing address

2 GRANITE ST
WORCESTER MA
01604-5428
US

V. Phone/Fax

Practice location:
  • Phone: 774-535-6950
  • Fax:
Mailing address:
  • Phone: 508-552-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN216817
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: