Provider Demographics
NPI:1063396331
Name:DEBOER, MELISSA ANN (ND, RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DEBOER
Suffix:
Gender:F
Credentials:ND, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 TARTAN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9563
Mailing Address - Country:US
Mailing Address - Phone:616-293-3000
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKE DR SE STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1673
Practice Address - Country:US
Practice Address - Phone:616-293-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294771163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health