Provider Demographics
NPI:1255854063
Name:MESIANO, MICHELLE (APN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MESIANO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6458
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:650 UNION BLVD STE 16
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:973-938-5200
Practice Address - Fax:973-938-5191
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00746600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily