MEDICARE: MARCIA A MELQUIST FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001234004	VA
2	163WH1000X	Hospice Registered Nurse	0001234004	VA
3	363LF0000X	Family Nurse Practitioner	0024178793	VA

General Provider Information

NPI Number	:	1164055372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA A MELQUIST FNP-C

Provider Business Mailing Address
First Line	:	5041 CORPORATE WOODS DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4375
Country	:	US
Telephone Number	:	757-567-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5041 CORPORATE WOODS DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4375
Country	:	US
Telephone Number	:	757-490-9323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2020
Last Update Date	:	05/30/2020

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