Provider Demographics
NPI:1417004490
Name:MELESKI, MARY LOUISE (RN, MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:MELESKI
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:MELESKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN,BC
Mailing Address - Street 1:307 PHINNEYS LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2545
Mailing Address - Country:US
Mailing Address - Phone:508-775-4935
Mailing Address - Fax:
Practice Address - Street 1:78 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-4008
Practice Address - Country:US
Practice Address - Phone:508-778-7525
Practice Address - Fax:508-778-7529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108533163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult