Healthcare Provider Details

I. General information

NPI: 1245386275
Provider Name (Legal Business Name): ELLEN M MELCHER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

IV. Provider business mailing address

2494 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-9850
  • Fax: 248-299-9860
Mailing address:
  • Phone: 248-299-9850
  • Fax: 248-299-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704195711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: