Healthcare Provider Details

I. General information

NPI: 1861177198
Provider Name (Legal Business Name): MELISSA SCHULZKE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 N STATE ST
OREM UT
84057-2025
US

IV. Provider business mailing address

1085 S 2750 E
SPRINGVILLE UT
84663-5598
US

V. Phone/Fax

Practice location:
  • Phone: 888-224-8250
  • Fax:
Mailing address:
  • Phone: 801-318-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10849760-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10849760-8900
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10849760-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: