Healthcare Provider Details

I. General information

NPI: 1174025027
Provider Name (Legal Business Name): MELISSA PILLAI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 HEALTH DR SW
WYOMING MI
49519
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
GRAND RAPIDS MI
49504-5617
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7494
  • Fax: 616-252-7830
Mailing address:
  • Phone: 616-252-3243
  • Fax: 616-252-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704292168
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704292168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: