Healthcare Provider Details

I. General information

NPI: 1184256380
Provider Name (Legal Business Name): MELISSA MARIE RIFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD STE 1010
WEST BLOOMFIELD MI
48323-2185
US

IV. Provider business mailing address

3888 ABERDEEN LN
BRIGHTON MI
48114-9258
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-9111
  • Fax:
Mailing address:
  • Phone: 586-201-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704291075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: