Provider Demographics
NPI:1790732055
Name:PLAVSA, MELISSA KAY (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:PLAVSA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:701 SUPERIOR AVE STE E
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4038
Practice Address - Country:US
Practice Address - Phone:219-922-4081
Practice Address - Fax:219-922-4087
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71001872A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q48631Medicare UPIN