Provider Demographics
NPI:1639195803
Name:BERKY, MELISSA R (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:BERKY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0918
Mailing Address - Country:US
Mailing Address - Phone:207-947-5337
Mailing Address - Fax:207-947-9163
Practice Address - Street 1:700 MT HOPE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-5337
Practice Address - Fax:207-947-9163
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER022319207V00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology