Provider Demographics
NPI:1346614823
Name:LLAVE, MELISSA ROSE (APN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:LLAVE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MOJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:27 SOUTH AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-868-1277
Mailing Address - Fax:
Practice Address - Street 1:27 SOUTH AVENUE WEST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016
Practice Address - Country:US
Practice Address - Phone:908-275-3810
Practice Address - Fax:908-275-8825
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00602200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily