Provider Demographics
NPI:1780234740
Name:CHRETIEN, MELISSA ANNE (RN, LMT, CLT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:CHRETIEN
Suffix:
Gender:F
Credentials:RN, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2713
Mailing Address - Country:US
Mailing Address - Phone:207-240-6310
Mailing Address - Fax:
Practice Address - Street 1:31 BATH RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2691
Practice Address - Country:US
Practice Address - Phone:207-240-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN61888163WC1500X, 163WM1400X, 163WX0200X
MEMT4230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WX0200XNursing Service ProvidersRegistered NurseOncology