Healthcare Provider Details

I. General information

NPI: 1669937108
Provider Name (Legal Business Name): MELISSA ANN BRIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 BOARDMAN CANFIELD RD STE 105
YOUNGSTOWN OH
44512-4236
US

IV. Provider business mailing address

10320 MIDWAY DR
NEW MIDDLETOWN OH
44442-7700
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-1964
  • Fax:
Mailing address:
  • Phone: 330-397-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033478
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN266806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: