Healthcare Provider Details

I. General information

NPI: 1003695636
Provider Name (Legal Business Name): MELISSA NUNCIO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DALLAS HILL RD
RANGELEY ME
04970-4032
US

IV. Provider business mailing address

PO BOX 727
WATERVILLE ME
04903-0727
US

V. Phone/Fax

Practice location:
  • Phone: 207-864-3303
  • Fax:
Mailing address:
  • Phone: 207-660-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20203089235
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP251835
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1138185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: