Provider Demographics
NPI:1134306160
Name:JOHNSON, MELISSA A (APNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:LAUTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1949
Mailing Address - Country:US
Mailing Address - Phone:920-324-6290
Mailing Address - Fax:
Practice Address - Street 1:1 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1949
Practice Address - Country:US
Practice Address - Phone:920-324-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily