1255885802 NPI number — MELISSA MEGHAN CONDREN MSN, RN, CPNP

Table of content: MELISSA MEGHAN CONDREN MSN, RN, CPNP (NPI 1255885802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255885802 NPI number — MELISSA MEGHAN CONDREN MSN, RN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDREN
Provider First Name:
MELISSA
Provider Middle Name:
MEGHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOSENSKY
Provider Other First Name:
MELISSA
Provider Other Middle Name:
MEGHAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255885802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-8885
Provider Business Mailing Address Fax Number:
508-334-1977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
282 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-9650
Provider Business Practice Location Address Fax Number:
860-545-9214
Provider Enumeration Date:
08/12/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN2305787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: RN2305787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110119073A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S400344616 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".