Provider Demographics
NPI:1013653914
Name:MALTESE, MELANIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MALTESE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S BALTIC PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5935
Mailing Address - Country:US
Mailing Address - Phone:208-887-4872
Mailing Address - Fax:
Practice Address - Street 1:14 S BALTIC PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5935
Practice Address - Country:US
Practice Address - Phone:208-887-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID71998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner