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General NPI Number Information
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NPI Number | 1235481110
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Entity Type | Individual
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Provider Name | MELANIE ELIZABETH CAMPBELL ATC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 119 GANNETT DR
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6942
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Country | US
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Telephone | 207-773-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 190 RIVERSIDE ST UNIT 6B
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City | PORTLAND
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State | ME
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Zip | 04103-1073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN58475
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337589-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP1511148
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License Number State | ME
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