Provider Demographics
NPI:1831715150
Name:MOUHTIS, MELANIE ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:MOUHTIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AVON CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3102
Mailing Address - Country:US
Mailing Address - Phone:609-626-1080
Mailing Address - Fax:
Practice Address - Street 1:128 ROUTE 70 STE 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2371
Practice Address - Country:US
Practice Address - Phone:609-367-0900
Practice Address - Fax:609-367-0901
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01038900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0743721Medicaid