Provider Demographics
NPI:1255749313
Name:CREIGHTON, MELISSA JILL (CNM)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JILL
Last Name:CREIGHTON
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 1:334 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1306
Mailing Address - Country:US
Mailing Address - Phone:914-528-3926
Mailing Address - Fax:
Practice Address - Street 1:334 ALPINE DR
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1306
Practice Address - Country:US
Practice Address - Phone:914-528-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001628367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife