Provider Demographics
NPI:1588942924
Name:BRETON, MELISSA WOOLDRIDGE (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:WOOLDRIDGE
Last Name:BRETON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROYCE CIRCLE, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268
Mailing Address - Country:US
Mailing Address - Phone:860-658-8750
Mailing Address - Fax:860-658-8769
Practice Address - Street 1:117 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2507
Practice Address - Country:US
Practice Address - Phone:860-658-8750
Practice Address - Fax:860-658-8769
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily