Provider Demographics
NPI:1235444225
Name:ANDERSON, MELISSA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:704 S WEBSTER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3528
Mailing Address - Country:US
Mailing Address - Phone:920-468-3444
Mailing Address - Fax:920-432-6313
Practice Address - Street 1:704 S WEBSTER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3528
Practice Address - Country:US
Practice Address - Phone:920-468-3444
Practice Address - Fax:920-432-6313
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WIANDI-0433-1706363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health