Provider Demographics
NPI:1760921324
Name:WINNS, MELISSA MARIE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:WINNS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11690 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9420
Mailing Address - Country:US
Mailing Address - Phone:616-710-6448
Mailing Address - Fax:
Practice Address - Street 1:11690 21 MILE RD
Practice Address - Street 2:
Practice Address - City:SAND LAKE
Practice Address - State:MI
Practice Address - Zip Code:49343-9420
Practice Address - Country:US
Practice Address - Phone:616-710-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health