Provider Demographics
NPI:1114300613
Name:TOMBACK, MELISSA S (CD(DONA))
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:S
Last Name:TOMBACK
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:S
Other - Last Name:TOMBACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD(DONA)
Mailing Address - Street 1:335 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3602
Mailing Address - Country:US
Mailing Address - Phone:617-308-7788
Mailing Address - Fax:
Practice Address - Street 1:335 SPRING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3602
Practice Address - Country:US
Practice Address - Phone:617-308-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula