Healthcare Provider Details

I. General information

NPI: 1053200535
Provider Name (Legal Business Name): MELANIE A ROGUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30713 SCHOENHERR RD
WARREN MI
48088-3122
US

IV. Provider business mailing address

30713 SCHOENHERR RD
MACOMB MI
48312
US

V. Phone/Fax

Practice location:
  • Phone: 586-284-2643
  • Fax: 586-265-2170
Mailing address:
  • Phone: 586-284-2643
  • Fax: 586-265-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704256423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: