Provider Demographics
NPI:1912398454
Name:WELCH, MELISSA ELICIA (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELICIA
Last Name:WELCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELICIA
Other - Last Name:DENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9530 DAUGHERTY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9111
Mailing Address - Country:US
Mailing Address - Phone:313-618-4391
Mailing Address - Fax:
Practice Address - Street 1:10146 E OLD VAIL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9406
Practice Address - Country:US
Practice Address - Phone:520-574-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010299A363L00000X, 363LF0000X
OHAPRN.CNP.0034997363L00000X, 363LF0000X
MI4704254903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner