Provider Demographics
NPI:1912383274
Name:GODAR, MELISSA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:GODAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:EILERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5551 WINGHAVEN BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3618
Mailing Address - Country:US
Mailing Address - Phone:314-944-3711
Mailing Address - Fax:660-205-2524
Practice Address - Street 1:5551 WINGHAVEN BLVD STE 20
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3618
Practice Address - Country:US
Practice Address - Phone:314-944-3711
Practice Address - Fax:660-205-2524
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009132363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily