Provider Demographics
NPI:1508403304
Name:LAGRANGE, MELISSA KAY (CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:LAGRANGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 LEVI'S COMMONS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:567-585-0380
Mailing Address - Fax:567-585-0381
Practice Address - Street 1:1601 BRIGHAM DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7117
Practice Address - Country:US
Practice Address - Phone:567-585-0380
Practice Address - Fax:567-585-0381
Is Sole Proprietor?:No
Enumeration Date:2019-11-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.026003OtherOHIO BOARD OF NURSING