Healthcare Provider Details

I. General information

NPI: 1396023719
Provider Name (Legal Business Name): MELISSA ANN CURTISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3076
  • Fax: 517-205-1432
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704242977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: