Provider Demographics
NPI:1144211475
Name:TORRES, MELISSA A (PAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:TORRES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 NAOMI ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1257
Mailing Address - Country:US
Mailing Address - Phone:269-552-0100
Mailing Address - Fax:269-552-0111
Practice Address - Street 1:345 NAOMI ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1257
Practice Address - Country:US
Practice Address - Phone:269-552-0100
Practice Address - Fax:269-552-0111
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMS002226OtherSTATE LICENSE #
P39040038Medicare PIN
MIMS002226OtherSTATE LICENSE #
P39040009Medicare PIN