Healthcare Provider Details

I. General information

NPI: 1629234943
Provider Name (Legal Business Name): MELISSA ROBIN PLOURDE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ROBIN VENTRICE

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINTER ST
WALTHAM MA
02451-1424
US

IV. Provider business mailing address

950 WINTER ST
WALTHAM MA
02451-1424
US

V. Phone/Fax

Practice location:
  • Phone: 413-977-6083
  • Fax: 781-419-8479
Mailing address:
  • Phone: 413-977-6083
  • Fax: 781-419-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number232592
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: