Provider Demographics
NPI:1285729681
Name:PEURA, MELISSA ANN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PEURA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:847-522-0307
Practice Address - Street 1:33475 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4614
Practice Address - Country:US
Practice Address - Phone:734-728-2423
Practice Address - Fax:734-728-2183
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704206066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704206066OtherSTATE LICENSE
MIF28634Medicare UPIN
MI0M86290Medicare ID - Type Unspecified