Provider Demographics
NPI:1902064769
Name:SMALLIGAN, MELISSA ANN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SMALLIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2010-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704228466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N55170017OtherMEDICARE ADVANTAGE
MI200000018097OtherPHP FAMILYCARE
MI5008773320OtherBLUE CROSS BLUE SHIELD
MI1059824OtherMCLAREN HEALTH ADVANTAGE
MI1059824OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI200000018097OtherPHP
MI9911520OtherAETNA
MI1059824OtherMCLAREN HEALTH PLAN-MEDICAID
MI9911520OtherAETNA