Basic Information
| Provider Information | |||||||||
| NPI: | 1851904684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WISEHEART | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4160 JOHN R ST STE 925 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457247 | ||||||||
| FaxNumber: | 3139930500 | ||||||||
| Practice Location | |||||||||
| Address1: | 4160 JOHN R ST STE 925 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457247 | ||||||||
| FaxNumber: | 3139930500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2020 | ||||||||
| LastUpdateDate: | 09/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704255849 | MI | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 4704255849 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.