Provider Demographics
NPI:1467111260
Name:REICHELT, MELISSA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:REICHELT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CHAMPAGNE RD
Mailing Address - Street 2:
Mailing Address - City:KINDE
Mailing Address - State:MI
Mailing Address - Zip Code:48445-9720
Mailing Address - Country:US
Mailing Address - Phone:989-551-1150
Mailing Address - Fax:
Practice Address - Street 1:170 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9781
Practice Address - Country:US
Practice Address - Phone:989-453-7301
Practice Address - Fax:989-453-7306
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily