Provider Demographics
NPI:1437791134
Name:WILLIS, MELISSA MARGARET (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:WILLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 OPUS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8694
Mailing Address - Country:US
Mailing Address - Phone:719-289-3173
Mailing Address - Fax:866-718-1677
Practice Address - Street 1:4729 OPUS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8694
Practice Address - Country:US
Practice Address - Phone:719-289-3173
Practice Address - Fax:866-718-1677
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013385363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health