Individual
MELISSA A DERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
725 S WEBSTER AVE, SUITE 201, GREEN BAY, WI 54301-3500
(920) 430-7100
(920) 430-7114
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4010-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010002130
AMERICAN NURSES CREDENTIALING CENTER
—
01
—
4010-33
LICENSE
WI
Enumeration date
04/05/2010
Last updated
07/14/2021
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