Provider Demographics
NPI:1689172058
Name:LECLAIR, MELISSA MARIE (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:LECLAIR
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:FAUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GOOD SAMARITAN WOMEN'S HEALTH
Practice Address - Street 2:830 OAK ST
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-408-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN226393163WM0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN226393OtherRN