Healthcare Provider Details

I. General information

NPI: 1720072531
Provider Name (Legal Business Name): MELISSA L BACH W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LIGHTHOUSE LANE
GOSHEN IN
46526-3824
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-0348
  • Fax: 574-533-0277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001002A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: