Provider Demographics
NPI:1598104572
Name:COPENHAVER, MELISSA (DNP, FNP-BC, LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:COPENHAVER
Suffix:
Gender:F
Credentials:DNP, FNP-BC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3009
Mailing Address - Country:US
Mailing Address - Phone:906-273-0964
Mailing Address - Fax:906-273-2005
Practice Address - Street 1:1209 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3009
Practice Address - Country:US
Practice Address - Phone:906-273-0964
Practice Address - Fax:906-273-2005
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010852541041C0700X
MI4704212488163W00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily