Healthcare Provider Details

I. General information

NPI: 1891129482
Provider Name (Legal Business Name): MELISSA ANNE DAVEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA LINDNER RN

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOSPITAL DR
WATERTOWN WI
53098
US

IV. Provider business mailing address

1025 MULBERRY ST
LAKE MILLS WI
53551-1304
US

V. Phone/Fax

Practice location:
  • Phone: 920-262-4825
  • Fax:
Mailing address:
  • Phone: 920-648-4518
  • Fax: 920-648-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9030-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number197134-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: