Provider Demographics
NPI:1578905105
Name:BELVIS, MELLIE U (APN)
Entity Type:Individual
Prefix:
First Name:MELLIE
Middle Name:U
Last Name:BELVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MELLIE
Other - Middle Name:VIGO
Other - Last Name:UCAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-C
Mailing Address - Street 1:2-18 LAMBERT RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1100
Mailing Address - Country:US
Mailing Address - Phone:201-475-2267
Mailing Address - Fax:
Practice Address - Street 1:2-18 LAMBERT RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1100
Practice Address - Country:US
Practice Address - Phone:201-475-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00389800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health