Provider Demographics
NPI:1770537672
Name:VUKOVICH, MELISSA (NP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:VUKOVICH
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 1:3365 S. 103RD STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4108
Mailing Address - Country:US
Mailing Address - Phone:262-814-7080
Mailing Address - Fax:262-432-9004
Practice Address - Street 1:3365 S 103RD ST STE 210
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53227-4108
Practice Address - Country:US
Practice Address - Phone:262-814-7080
Practice Address - Fax:262-432-9004
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1588-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770537672Medicaid
P06508Medicare UPIN
WI43917200Medicaid
0020L73601Medicare ID - Type Unspecified
WI1770537672Medicaid