MEDICARE: MELISSA ANNE PETERS 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
1	207QA0505X	Adult Medicine Physician	RN.386557	OH

General Provider Information

NPI Number	:	1982217352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE PETERS NP

Provider Business Mailing Address
First Line	:	4525 DEMOREST RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7935
Country	:	US
Telephone Number	:	614-597-4452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2930
Country	:	US
Telephone Number	:	614-597-4452
Fax Number	:

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

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	09/18/2020

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