Basic Information
| Provider Information | |||||||||
| NPI: | 1144211475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 NAOMI ST | ||||||||
| Address2: | |||||||||
| City: | PLAINWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490801257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695520100 | ||||||||
| FaxNumber: | 2695520111 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 NAOMI ST | ||||||||
| Address2: | |||||||||
| City: | PLAINWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490801257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695520100 | ||||||||
| FaxNumber: | 2695520111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601002226 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | MS002226 | 01 | MI | STATE LICENSE # | OTHER |