Provider Demographics
NPI:1417696816
Name:HALL, MELISSA RENEE (APRN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUGAR MAPLE LN APT 21
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5748
Mailing Address - Country:US
Mailing Address - Phone:314-546-6006
Mailing Address - Fax:
Practice Address - Street 1:224 S WOODS MILL RD STE 410
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3513
Practice Address - Country:US
Practice Address - Phone:636-685-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033728208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice