Provider Demographics
NPI:1851643498
Name:SMITH, MELISSA ANNE (APNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:SMITH
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Gender:F
Credentials:APNP
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Mailing Address - Street 1:2845 GREENBRIAR ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54208-8900
Mailing Address - Country:US
Mailing Address - Phone:920-288-8100
Mailing Address - Fax:920-288-8637
Practice Address - Street 1:2845 GREENBRIAR ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54208-8900
Practice Address - Country:US
Practice Address - Phone:920-288-8100
Practice Address - Fax:920-288-8637
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2021-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI5056-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner