Provider Demographics
NPI:1669722401
Name:NIXON, MELISSA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:NIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8820
Mailing Address - Country:US
Mailing Address - Phone:989-345-7000
Mailing Address - Fax:989-345-7479
Practice Address - Street 1:3190 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739-9276
Practice Address - Country:US
Practice Address - Phone:989-728-6000
Practice Address - Fax:989-728-6003
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704245250OtherLICENSE