Provider Demographics
NPI:1316421068
Name:ELLIOTT, MELISSA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11316 WHITETAIL RUN STREET, NW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612
Mailing Address - Country:US
Mailing Address - Phone:330-340-5309
Mailing Address - Fax:
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 425
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2340
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH265257163W00000X
OH023647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse