Healthcare Provider Details

I. General information

NPI: 1619896099
Provider Name (Legal Business Name): MELISSA MARIE HAMACHEK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 GLORY RD STE A
GREEN BAY WI
54304-5664
US

IV. Provider business mailing address

1048 GLORY RD STE A
GREEN BAY WI
54304-5664
US

V. Phone/Fax

Practice location:
  • Phone: 920-238-8155
  • Fax: 920-214-1259
Mailing address:
  • Phone: 920-238-8155
  • Fax: 920-214-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18684-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: