Provider Demographics
NPI:1104108554
Name:WIEST, MELANIE LYN (ANP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYN
Last Name:WIEST
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LYN
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12006 KILARNEY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7207
Mailing Address - Country:US
Mailing Address - Phone:540-786-9771
Mailing Address - Fax:540-548-8803
Practice Address - Street 1:4500 POND WAY STE 170
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5596
Practice Address - Country:US
Practice Address - Phone:571-542-4950
Practice Address - Fax:571-285-1160
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005287363LA2200X
VA0024172873363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005557Medicaid
VA1104108554Medicaid
VAVVJ293AMedicare PIN
VA1104108554Medicaid