Provider Demographics
NPI:1245386275
Name:MELCHER, ELLEN M (CNP)
Entity type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:M
Last Name:MELCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3817
Mailing Address - Country:US
Mailing Address - Phone:248-299-9850
Mailing Address - Fax:248-299-9860
Practice Address - Street 1:2494 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-299-9850
Practice Address - Fax:248-299-9860
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195711363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704195711OtherSTATE LICENSE
MI4704195711OtherNURSE PRACTITIONER LICENSE #
MI5008673580OtherBCBS INDIVIDUAL PIN #
MI1245386275OtherNPI
MI1245386275OtherNPI