Provider Demographics
NPI:1457363129
Name:BEYER-THISTLE, MELISSA AMY (MS, CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:AMY
Last Name:BEYER-THISTLE
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:AMY
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CRNP
Mailing Address - Street 1:8821 COLUMBIA 100 PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2168
Mailing Address - Country:US
Mailing Address - Phone:410-964-1056
Mailing Address - Fax:410-740-8315
Practice Address - Street 1:8821 COLUMBIA 100 PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2168
Practice Address - Country:US
Practice Address - Phone:410-964-1056
Practice Address - Fax:410-740-8315
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR095831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR095831OtherREGISTERED NURSE