Provider Demographics
NPI:1922815810
Name:WEST, MELISSA GRACE (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:WEST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GRACE
Other - Last Name:NATIVIDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2175 COOLIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1379
Mailing Address - Country:US
Mailing Address - Phone:517-349-3900
Mailing Address - Fax:517-999-3024
Practice Address - Street 1:451 HIDDEN MEADOWS DR STE 290
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9812
Practice Address - Country:US
Practice Address - Phone:517-349-4900
Practice Address - Fax:517-349-3704
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704372436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner