Provider Demographics
NPI:1265790794
Name:MARTIN, MELANIE MICHELLE (DNP)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MICHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:MICHELLE
Other - Last Name:GOEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7222 HARDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MI
Mailing Address - Zip Code:49879-9074
Mailing Address - Country:US
Mailing Address - Phone:906-281-3745
Mailing Address - Fax:906-936-6681
Practice Address - Street 1:101 EMPIRE MINE RD
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849
Practice Address - Country:US
Practice Address - Phone:906-475-3606
Practice Address - Fax:906-936-6681
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704211952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011019266OtherAMERICAN NURSES CREDENTIALING CENTER