Provider Demographics
NPI:1114992385
Name:MAES, MELISSA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:MAES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 E FORT LOWELL RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2208
Mailing Address - Country:US
Mailing Address - Phone:520-495-2100
Mailing Address - Fax:
Practice Address - Street 1:1353 E FORT LOWELL RD
Practice Address - Street 2:UNIT A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2208
Practice Address - Country:US
Practice Address - Phone:520-495-2100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#AP1636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily