Healthcare Provider Details

I. General information

NPI: 1801158647
Provider Name (Legal Business Name): MELISSA THOMAS BSN, MSN, APN-C,CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FRIES MILL RD SUITE 301
BLACKWOOD NJ
08012-2016
US

IV. Provider business mailing address

333 LAUREL OAK RD
VOORHEES NJ
08043-4453
US

V. Phone/Fax

Practice location:
  • Phone: 856-374-1881
  • Fax:
Mailing address:
  • Phone: 856-344-7360
  • Fax: 856-783-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00365600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011786
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: