Provider Demographics
NPI:1639626922
Name:HULTMAN, MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HULTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:520 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1762
Mailing Address - Country:US
Mailing Address - Phone:269-783-2080
Mailing Address - Fax:269-783-2090
Practice Address - Street 1:520 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1762
Practice Address - Country:US
Practice Address - Phone:269-783-2080
Practice Address - Fax:269-783-2090
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant