Healthcare Provider Details

I. General information

NPI: 1053250167
Provider Name (Legal Business Name): BRENNA MELICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

IV. Provider business mailing address

650 MARYVILLE UNIVERSITY DR
SAINT LOUIS MO
63141-5849
US

V. Phone/Fax

Practice location:
  • Phone: 551-295-8223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ15586600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: