Provider Demographics
NPI:1326689001
Name:MARTEL, MELISSA CORRIE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CORRIE
Last Name:MARTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2779
Mailing Address - Country:US
Mailing Address - Phone:207-659-4418
Mailing Address - Fax:
Practice Address - Street 1:444 STILLWATER AVE STE 210
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3500
Practice Address - Country:US
Practice Address - Phone:207-573-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1326689001Medicaid