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General NPI Number Information
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NPI Number | 1073262903
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Entity Type | Individual
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Provider Name | MELISSA NELL GINGERICH
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Gender | Female
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 1501 N FLORENCE AVE
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City | CLAREMORE
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State | OK
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Zip | 74017-3179
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Country | US
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Telephone | 918-579-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 3205 CALLAWAY DR
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City | CLAREMORE
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State | OK
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Zip | 74019-4824
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Country | US
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Telephone | 918-559-9747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 109502
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License Number State | OK
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