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NPI Code Detail

MEDICARE: MRS. MELISSA ANN FOGT APRN-CNP

MEDICARE:  MRS. MELISSA ANN FOGT  APRN-CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0028377OH

General Provider Information

NPI Number : 1073106746
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA ANN FOGT APRN-CNP
Provider Business Mailing Address
First Line : 1001 BELLEFONTAINE AVE
Second Line :
City : LIMA
State : OH
Zip : 45804-2800
Country : US
Telephone Number : 419-226-5018
Fax Number : 419-998-4514
Provider Business Practice Location Address
First Line : 1007 W AUGLAIZE ST
Second Line :
City : WAPAKONETA
State : OH
Zip : 45895-1351
Country : US
Telephone Number : 419-738-9601
Fax Number : 419-738-9749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2021
Last Update Date : 11/19/2024

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