Provider Demographics
NPI:1497881833
Name:CONNORS, MELANIE F (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:F
Last Name:CONNORS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MARGINAL WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2438
Mailing Address - Country:US
Mailing Address - Phone:207-773-7964
Mailing Address - Fax:207-773-9073
Practice Address - Street 1:161 MARGINAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2438
Practice Address - Country:US
Practice Address - Phone:207-773-7964
Practice Address - Fax:207-773-9073
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER050561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432561199Medicaid
ME000150601Medicare PIN
ME432561199Medicaid