Healthcare Provider Details

I. General information

NPI: 1124967013
Provider Name (Legal Business Name): MELISSA WOODWORTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

282 BENEDICT AVE
NORWALK OH
44857-2712
US

IV. Provider business mailing address

314 JAMES ST
LAKESIDE MARBLEHEAD OH
43440-2121
US

V. Phone/Fax

Practice location:
  • Phone: 419-518-8613
  • Fax:
Mailing address:
  • Phone: 419-518-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: