Provider Demographics
NPI:1457672636
Name:DEWAR, MELISSA HEATHER (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:HEATHER
Last Name:DEWAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 PENNSYLVANIA AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1203
Mailing Address - Country:US
Mailing Address - Phone:646-945-5996
Mailing Address - Fax:
Practice Address - Street 1:1155 PENNSYLVANIA AVE APT 6H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1203
Practice Address - Country:US
Practice Address - Phone:646-945-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse