Provider Demographics
NPI:1790788735
Name:INZENGA, MELISSA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:INZENGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:208 ROBINSON RD.
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051
Mailing Address - Country:US
Mailing Address - Phone:603-577-3410
Mailing Address - Fax:603-577-3422
Practice Address - Street 1:208 ROBINSON RD.
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051
Practice Address - Country:US
Practice Address - Phone:603-577-3410
Practice Address - Fax:603-577-3422
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30333360Medicaid
NH30333360Medicaid
NHAP2330Medicare PIN