Basic Information
| Provider Information | |||||||||
| NPI: | 1902064769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALLIGAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704228466 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0N55170017 | 01 | MI | MEDICARE ADVANTAGE | OTHER | 200000018097 | 01 | MI | PHP FAMILYCARE | OTHER | 5008773320 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1059824 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1059824 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 200000018097 | 01 | MI | PHP | OTHER | 9911520 | 01 | MI | AETNA | OTHER | 1059824 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER |