Provider Demographics
NPI:1851018949
Name:MONTALBINE, MELISSA (NP, RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MONTALBINE
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:TYSON
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5918 HARBOUR PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2163
Mailing Address - Country:US
Mailing Address - Phone:804-639-0400
Mailing Address - Fax:804-639-0445
Practice Address - Street 1:5918 HARBOUR PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2163
Practice Address - Country:US
Practice Address - Phone:804-639-0400
Practice Address - Fax:804-639-0445
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001078677163W00000X
VA0024185237363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner