Provider Demographics
NPI:1760004790
Name:MATHER, MELISSA M (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MATHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:612 KINGSBOROUGH SQ STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5055
Mailing Address - Country:US
Mailing Address - Phone:757-609-3380
Mailing Address - Fax:757-609-3384
Practice Address - Street 1:612 KINGSBOROUGH SQ STE 300
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5055
Practice Address - Country:US
Practice Address - Phone:757-609-3380
Practice Address - Fax:757-609-3384
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180238363LG0600X, 363LC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program