Healthcare Provider Details

I. General information

NPI: 1396296166
Provider Name (Legal Business Name): MELISSA NORTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MAYHEW

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BIRCH RUN RD STE D
BIRCH RUN MI
48415
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-1575
  • Fax: 989-624-1507
Mailing address:
  • Phone: 989-362-9411
  • Fax: 989-362-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4204264150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: