Provider Demographics
NPI:1164556940
Name:HARDWICK, MELISSA A (RN MSN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ALEX
Other - Last Name:BOLSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:2406 TUMBLEWEED TRL
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313
Mailing Address - Country:US
Mailing Address - Phone:920-434-6142
Mailing Address - Fax:920-845-2128
Practice Address - Street 1:N6185 SCHOOL CREEK TRL
Practice Address - Street 2:
Practice Address - City:LUXEMBERG
Practice Address - State:WI
Practice Address - Zip Code:54217
Practice Address - Country:US
Practice Address - Phone:920-845-2128
Practice Address - Fax:920-845-2128
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35016200Medicaid