Provider Demographics
NPI:1356053862
Name:MAXSON-MATTERN, MELISSA S (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:MAXSON-MATTERN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1735
Mailing Address - Country:US
Mailing Address - Phone:607-773-4389
Mailing Address - Fax:
Practice Address - Street 1:444 JENNINGS CREEK RD
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:NY
Practice Address - Zip Code:13803-3836
Practice Address - Country:US
Practice Address - Phone:607-232-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629176163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health