Healthcare Provider Details

I. General information

NPI: 1700779071
Provider Name (Legal Business Name): MELISSA A HARRIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A HASKINS

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5500
  • Fax:
Mailing address:
  • Phone: 734-845-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703125405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: