Provider Demographics
NPI:1861177198
Name:SCHULZKE, MELISSA (PMHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SCHULZKE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 S 2750 E
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5598
Mailing Address - Country:US
Mailing Address - Phone:801-318-1107
Mailing Address - Fax:
Practice Address - Street 1:1790 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:888-224-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10849760-3102163W00000X
UT10849760-4405363LP0808X
UT10849760-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse