Provider Demographics
NPI:1801390240
Name:KEUNEKE, MELISA ANNA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:ANNA
Last Name:KEUNEKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1178 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2461
Mailing Address - Country:US
Mailing Address - Phone:419-238-6251
Mailing Address - Fax:419-232-2090
Practice Address - Street 1:1178 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2461
Practice Address - Country:US
Practice Address - Phone:419-238-6251
Practice Address - Fax:419-232-2090
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner