| NPI | 1346737608 |
|---|---|
| Former Name | MELISSA MICKELSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 58030) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ID 58030) |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2021-05-25 |