Provider Demographics
NPI:1033652987
Name:GARDNER, MELISSA (CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1959
Mailing Address - Country:US
Mailing Address - Phone:413-584-2173
Mailing Address - Fax:
Practice Address - Street 1:59 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1959
Practice Address - Country:US
Practice Address - Phone:413-584-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280655363LA2200X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health