Provider Demographics
NPI:1033731195
Name:MILVENAN, MELISSA (RN, APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MILVENAN
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SHAWS CV
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4902
Mailing Address - Country:US
Mailing Address - Phone:860-447-8304
Mailing Address - Fax:
Practice Address - Street 1:1 SHAWS CV
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4902
Practice Address - Country:US
Practice Address - Phone:860-447-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner