Individual
MELISSA L BACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
W.H.N.P.
Contact information
Practice address
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001002A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000390739
ANTHEM BCBS
—
05
—
200355360
—
IN
Enumeration date
09/07/2005
Last updated
08/30/2023
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