Healthcare Provider Details

I. General information

NPI: 1477937894
Provider Name (Legal Business Name): MELANIE BUSEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date: 06/12/2023
Reactivation Date: 07/13/2023

III. Provider practice location address

15 OAK ST
SPRINGVALE ME
04083-1926
US

IV. Provider business mailing address

15 OAK ST
SPRINGVALE ME
04083-1926
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-6900
  • Fax:
Mailing address:
  • Phone: 207-490-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number045430-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022559
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN217707
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134807
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP191022
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: