Provider Demographics
NPI:1649571175
Name:SMITH, MELISSA ANNE (MSN, APN)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:BOISSELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APN
Mailing Address - Street 1:1200 S CHURCH ST STE 18
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2936
Mailing Address - Country:US
Mailing Address - Phone:856-639-6500
Mailing Address - Fax:856-329-7827
Practice Address - Street 1:1200 S CHURCH ST STE 18
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2936
Practice Address - Country:US
Practice Address - Phone:856-639-6500
Practice Address - Fax:856-329-7827
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12116300163WC1600X, 163WP0808X
NJ26NJ01009500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821702564OtherNPI2
NJ0905976Medicaid