Healthcare Provider Details

I. General information

NPI: 1225539463
Provider Name (Legal Business Name): MRS. MELISSA ANN GUSHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 N STEWART RD
MANSFIELD OH
44903-9794
US

IV. Provider business mailing address

600 W 3RD ST
MANSFIELD OH
44906-2633
US

V. Phone/Fax

Practice location:
  • Phone: 419-989-1651
  • Fax:
Mailing address:
  • Phone: 419-525-6774
  • Fax: 419-525-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN.344714
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025864
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: