1164556940 NPI number — MRS. MELISSA A HARDWICK RN MSN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164556940 NPI number — MRS. MELISSA A HARDWICK RN MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDWICK
Provider First Name:
MELISSA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOLSSEN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ALEX
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164556940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 TUMBLEWEED TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-434-6142
Provider Business Mailing Address Fax Number:
920-845-2128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N6185 SCHOOL CREEK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUXEMBERG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-845-2128
Provider Business Practice Location Address Fax Number:
920-845-2128
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35016200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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