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General NPI Number Information
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NPI Number | 1942909064
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Entity Type | Individual
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Provider Name | MELISSA THEVENIN NP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 489 TURNPIKE ST
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City | SOUTH EASTON
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State | MA
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Zip | 02375-1738
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Country | US
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Telephone | 508-208-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 COMMERCIAL ST
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City | WEYMOUTH
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State | MA
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Zip | 02189-3082
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2310677
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2310677
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License Number State | MA
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