Provider Demographics
NPI:1598931040
Name:BROCK, MELISSA Y (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:Y
Last Name:BROCK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2415 DIRECTORS ROW
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4940
Mailing Address - Country:US
Mailing Address - Phone:317-694-7422
Mailing Address - Fax:317-381-0121
Practice Address - Street 1:2415 DIRECTORS ROW
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4940
Practice Address - Country:US
Practice Address - Phone:317-694-7422
Practice Address - Fax:317-381-0121
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2016-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002717A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily