Provider Demographics
NPI:1952112476
Name:THORSON, MELISSA LYNN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:THORSON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:734-236-6414
Mailing Address - Fax:
Practice Address - Street 1:3135 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-236-6414
Practice Address - Fax:734-353-4298
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024058406363LP0808X
MI2024058406363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health