Provider Demographics
NPI:1790299980
Name:WELTER, MELISSA A (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:WELTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:673MDG
Mailing Address - Street 2:5955 ZEAMER AVENUE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:907-580-3205
Mailing Address - Fax:
Practice Address - Street 1:673MDG
Practice Address - Street 2:5955 ZEAMER AVENUE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99506
Practice Address - Country:US
Practice Address - Phone:907-580-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57028363LF0000X
WAAP60819908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily