Provider Demographics
NPI:1699864504
Name:MCINNIS, MELINDA S (FNPC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:S
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:S
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:PENOBSCOT COMMUNITY HEALTH CENTER
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:735 WILSON STREET
Practice Address - Street 2:PENOBSCOT COMMUNITY HEALTH CENTER/ EXTENDED CARE SERVIC
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-992-2601
Practice Address - Fax:207-989-2280
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81598363LF0000X
MER039098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432301999Medicaid
ME432301999Medicaid