Individual
STACEY MELISSA MELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906
(765) 448-8000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28222616A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71008063A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001189856
ANTHEM PROVIDER NUMBER
IN
05
—
300018556
—
IN
Enumeration date
03/22/2018
Last updated
02/13/2025
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