Provider Demographics
NPI:1427705151
Name:LIBBY, MELISSA LYNN (CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LIBBY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5678
Mailing Address - Country:US
Mailing Address - Phone:207-947-5337
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 420
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5678
Practice Address - Country:US
Practice Address - Phone:207-947-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM222002367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife