Healthcare Provider Details

I. General information

NPI: 1699864504
Provider Name (Legal Business Name): MELINDA S MCINNIS FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA S PLUNKETT

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 TYLER AVE
BANGOR ME
04401-3726
US

IV. Provider business mailing address

38 TYLER AVE
BANGOR ME
04401-3726
US

V. Phone/Fax

Practice location:
  • Phone: 207-951-4336
  • Fax: 980-495-8899
Mailing address:
  • Phone: 207-951-4336
  • Fax: 980-495-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81598
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: