Healthcare Provider Details

I. General information

NPI: 1023353174
Provider Name (Legal Business Name): MELISSA M DVORSCAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 VILLAGE PT
CHESTERTON IN
46304-9694
US

IV. Provider business mailing address

1 AMERICAN SQ STE 2610
INDIANAPOLIS IN
46282-0004
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-4835
  • Fax: 855-220-2073
Mailing address:
  • Phone: 317-559-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28096838A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: