Provider Demographics
NPI:1720651060
Name:GASPAR, MELISSA P
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:P
Last Name:GASPAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DONASCO
Other - Last Name:PELAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1204 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2810
Mailing Address - Country:US
Mailing Address - Phone:248-977-6724
Mailing Address - Fax:
Practice Address - Street 1:1204 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2810
Practice Address - Country:US
Practice Address - Phone:248-977-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95248419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse