Provider Demographics
NPI:1306900147
Name:WAIDE, MELISSA (CPNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WAIDE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:601 CHILDRENS LN STE 5E
Mailing Address - Street 2:CHKD
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7713
Mailing Address - Fax:757-668-7711
Practice Address - Street 1:601 CHILDRENS LN STE 5E
Practice Address - Street 2:CHKD
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7713
Practice Address - Fax:757-668-7711
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165735363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics