Healthcare Provider Details

I. General information

NPI: 1396296166
Provider Name (Legal Business Name): MELISSA NORTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MAYHEW

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 WOODYARD RD
CLINTON MD
20735-2754
US

IV. Provider business mailing address

11885 BUCK PL
WALDORF MD
20601-7217
US

V. Phone/Fax

Practice location:
  • Phone: 240-746-1330
  • Fax:
Mailing address:
  • Phone: 810-853-9763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR271340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: