Provider Demographics
NPI:1700484524
Name:LEE, MELISSA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LEE
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 1:4200 FASHION SQUARE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1375
Mailing Address - Country:US
Mailing Address - Phone:989-729-4206
Mailing Address - Fax:989-729-4207
Practice Address - Street 1:4200 FASHION SQUARE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1375
Practice Address - Country:US
Practice Address - Phone:989-729-4206
Practice Address - Fax:989-729-4207
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248579NSA200RJ363LP2300X
MI4704248579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700484524Medicaid