Provider Demographics
NPI:1649668211
Name:THOMPSON, MELISSA A (ANP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:MAXTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:300 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6533
Mailing Address - Country:US
Mailing Address - Phone:732-349-4030
Mailing Address - Fax:732-244-1866
Practice Address - Street 1:300 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6533
Practice Address - Country:US
Practice Address - Phone:732-349-4030
Practice Address - Fax:732-244-1866
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00537900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner