Provider Demographics
NPI:1669937108
Name:BRIAN, MELISSA ANN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BRIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-7700
Mailing Address - Country:US
Mailing Address - Phone:330-397-6660
Mailing Address - Fax:
Practice Address - Street 1:833 BOARDMAN CANFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4236
Practice Address - Country:US
Practice Address - Phone:330-953-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN266806163W00000X
OHAPRN.CNP.0033478363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse