Provider Demographics
NPI:1902170392
Name:HACKETT, MELISSA C (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:HACKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GARDINER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357
Mailing Address - Country:US
Mailing Address - Phone:207-737-4359
Mailing Address - Fax:207-737-4412
Practice Address - Street 1:24 GARDINER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357
Practice Address - Country:US
Practice Address - Phone:207-737-4359
Practice Address - Fax:207-737-4412
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP121011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily