Healthcare Provider Details

I. General information

NPI: 1518887587
Provider Name (Legal Business Name): MELISSA YOUNG-FAIRWEATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTH ST
PEPPERELL MA
01463-1403
US

IV. Provider business mailing address

22 NORTH ST
PEPPERELL MA
01463-1403
US

V. Phone/Fax

Practice location:
  • Phone: 978-204-9416
  • Fax:
Mailing address:
  • Phone: 978-204-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2346038
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: