Provider Demographics
NPI:1922314350
Name:STEPCHUK, MELISSA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:STEPCHUK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67000 DEPARTMENT 272801
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-205-6248
Mailing Address - Fax:517-205-7419
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-7289
Practice Address - Fax:517-205-1322
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0211046363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health