Provider Demographics
NPI:1093484131
Name:GROTE, MELISSA (APRN CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GROTE
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 STORMY WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-3623
Mailing Address - Country:US
Mailing Address - Phone:606-219-8370
Mailing Address - Fax:
Practice Address - Street 1:707 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3462
Practice Address - Country:US
Practice Address - Phone:937-535-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily