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NPI Code Detail

MEDICARE: MELISSA ANN PEURA NP

MEDICARE: MELISSA ANN PEURA NP
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
1363L00000XNurse Practitioner4704206066MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704206066OTHERMISTATE LICENSE

General Provider Information

NPI Number : 1285729681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANN PEURA NP
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number : 947-522-1863
Fax Number : 847-522-0307
Provider Business Practice Location Address
First Line : 33475 PALMER RD
Second Line :
City : WESTLAND
State : MI
Zip : 48186-4614
Country : US
Telephone Number : 734-728-2423
Fax Number : 734-728-2183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 12/22/2022

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