Provider Demographics
NPI:1861622755
Name:THORNTON-HUYCKE, MELANIE DAWN (CNM)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:THORNTON-HUYCKE
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 1:3017 N NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9711 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3323
Practice Address - Country:US
Practice Address - Phone:301-762-5501
Practice Address - Fax:301-309-8727
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000694367A00000X
MDR071031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419321100Medicaid
MD419321100Medicaid
MD173094ZAEMedicare PIN