Provider Demographics
NPI:1265740948
Name:WIREBAUGH, MELISSA ANN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:WIREBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:FALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:51 HOWDER STREET
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242
Mailing Address - Country:US
Mailing Address - Phone:517-425-0654
Mailing Address - Fax:
Practice Address - Street 1:47 EAST SAINT JOE ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242
Practice Address - Country:US
Practice Address - Phone:517-607-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care