Provider Demographics
NPI:1477028751
Name:LEVINE, MELANIE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3422
Mailing Address - Country:US
Mailing Address - Phone:734-219-4175
Mailing Address - Fax:
Practice Address - Street 1:39500 W 10 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2947
Practice Address - Country:US
Practice Address - Phone:616-965-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704325570363LP0808X
COAPN.0997863-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty