Healthcare Provider Details

I. General information

NPI: 1184964355
Provider Name (Legal Business Name): MELISSA L GELLINGS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N LAKE DR SUITE 404
MILWAUKEE WI
53211-4528
US

IV. Provider business mailing address

2350 N LAKE DR SUITE 404
MILWAUKEE WI
53211-4528
US

V. Phone/Fax

Practice location:
  • Phone: 414-449-2223
  • Fax: 414-449-2259
Mailing address:
  • Phone: 414-449-2223
  • Fax: 414-449-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number125285-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5243-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: