Provider Demographics
NPI:1801158647
Name:THOMAS, MELISSA (BSN, MSN, APN-C,CRNP)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BSN, MSN, APN-C,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4453
Mailing Address - Country:US
Mailing Address - Phone:856-344-7360
Mailing Address - Fax:856-783-1403
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00365600363LA2200X
PASP011786363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health