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Individual

MRS. MELISSA MARIE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
450 E MAIN ST, REXBURG, ID 83440-2048
(208) 359-9811
Mailing address
330 CIRCLE DR, RIGBY, ID 83442-1375
(916) 204-7056

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
59333
ID
207QS1201X
Sleep Medicine (Family Medicine) Physician
59333
ID
363LF0000X
Family Nurse Practitioner
Primary
59333
ID

Other

Enumeration date
02/06/2023
Last updated
07/28/2026
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