Healthcare Provider Details

I. General information

NPI: 1225640113
Provider Name (Legal Business Name): MELISSA DIANE GARTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631-5154
US

IV. Provider business mailing address

1801 16TH ST
GREELEY CO
80631-5154
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-3894
  • Fax:
Mailing address:
  • Phone: 970-810-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0995762-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: