MEDICARE: MELISSA MARY EMERALD NOA FNP

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
1	363LF0000X	Family Nurse Practitioner	4704291862NSA24032	MI

General Provider Information

NPI Number	:	1295598035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARY EMERALD NOA FNP

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N OTSEGO AVE
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-1558
Country	:	US
Telephone Number	:	989-731-7760
Fax Number	:	989-731-7760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	05/15/2026

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