Provider Demographics
NPI:1053782185
Name:LEOPOLD, MELISSA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LEOPOLD
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 DEER RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-7427
Mailing Address - Country:US
Mailing Address - Phone:715-939-2451
Mailing Address - Fax:
Practice Address - Street 1:425 PINE RIDGE BLVD STE 220A
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4123
Practice Address - Country:US
Practice Address - Phone:715-847-2070
Practice Address - Fax:715-843-1343
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12005-33363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily