Provider Demographics
NPI:1235634189
Name:DESUEZA, MELISSA AMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:AMY
Last Name:DESUEZA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 PARK AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1989
Mailing Address - Country:US
Mailing Address - Phone:973-684-8138
Mailing Address - Fax:973-684-0032
Practice Address - Street 1:416 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1989
Practice Address - Country:US
Practice Address - Phone:973-684-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00812400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily