Healthcare Provider Details

I. General information

NPI: 1225275944
Provider Name (Legal Business Name): MELISSA B OUTERBRIDGE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 BRADLEE RD
MEDFORD MA
02155-3110
US

IV. Provider business mailing address

13 BRADLEE RD
MEDFORD MA
02155-3110
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-1110
  • Fax: 781-395-8553
Mailing address:
  • Phone: 781-395-1110
  • Fax: 781-395-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number236244
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: