Healthcare Provider Details

I. General information

NPI: 1477977767
Provider Name (Legal Business Name): MELISSA E HOLDERREAD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEMORIAL DR STE 403
SOUTH BEND IN
46601
US

IV. Provider business mailing address

3245 HEALTH DRIVE SUITE 100
GRANGER IN
46530-3245
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1405
  • Fax: 574-647-3970
Mailing address:
  • Phone: 574-647-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000237A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: