Provider Demographics
NPI:1700035656
Name:MALONEY, MELISSA KEIREN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KEIREN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 WALLACE BASHAW WAY
Mailing Address - Street 2:STE 2002
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3875
Mailing Address - Country:US
Mailing Address - Phone:978-465-0635
Mailing Address - Fax:978-465-0941
Practice Address - Street 1:1 WALLACE BASHAW WAY
Practice Address - Street 2:STE 2002
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3875
Practice Address - Country:US
Practice Address - Phone:978-465-0635
Practice Address - Fax:978-465-0941
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274078363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health