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General NPI Number Information
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NPI Number | 1508731480
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Entity Type | Individual
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Provider Name | MELISSA HERSOM
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Gender | Female
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 522 BATH RD
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City | WISCASSET
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State | ME
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Zip | 04578-4640
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Country | US
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Telephone | 207-315-8605
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Fax |
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Provider Business Mailing Address
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Address Line | 88 MIDDLE RD
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City | EDGECOMB
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State | ME
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Zip | 04556-3124
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | RN79489
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License Number State | ME
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