Provider Demographics
NPI:1033585518
Name:GRCICH, MELISSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRCICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 MCCOOL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8894
Mailing Address - Country:US
Mailing Address - Phone:574-933-3250
Mailing Address - Fax:
Practice Address - Street 1:786 MCCOOL RD STE 6
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8894
Practice Address - Country:US
Practice Address - Phone:844-457-8503
Practice Address - Fax:844-457-8503
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28173182A163W00000X
INF0915265363LF0000X
IN71006029A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse