Healthcare Provider Details

I. General information

NPI: 1780395285
Provider Name (Legal Business Name): MELISSA THOMAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 4TH ST
MADDOCK ND
58348-7129
US

IV. Provider business mailing address

PO BOX 314
MADDOCK ND
58348-0314
US

V. Phone/Fax

Practice location:
  • Phone: 701-799-7746
  • Fax:
Mailing address:
  • Phone: 701-799-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR36084
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: