Provider Demographics
NPI:1740505429
Name:HALABY, MELISSA SUE (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:HALABY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 ELLIOTT DRIVE
Mailing Address - Street 2:MICHIGAN HEART
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-712-8000
Mailing Address - Fax:734-712-8201
Practice Address - Street 1:5325 ELLIOTT DRIVE
Practice Address - Street 2:MICHIGAN HEART
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-8000
Practice Address - Fax:734-712-8201
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH16128171Medicare PIN