Healthcare Provider Details

I. General information

NPI: 1033585518
Provider Name (Legal Business Name): MELISSA GRCICH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 MCCOOL RD STE 6
VALPARAISO IN
46385-8894
US

IV. Provider business mailing address

786 MCCOOL RD STE 6
VALPARAISO IN
46385-8894
US

V. Phone/Fax

Practice location:
  • Phone: 844-457-8503
  • Fax: 844-457-8503
Mailing address:
  • Phone: 574-933-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28173182A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0915265
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: