Melanie Amanda Ellis, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Green Lake, WI
NPI 1376414466 · NPPES record last updated Sep 13, 2025
Key facts
- NPI
- 1376414466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 17426-33 (WI)
- Practice address
- PO Box 97
Green Lake, WI 54941-0097 - Phone
- (920) 229-0686
- NPI assigned
- Sep 13, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1846 E Innovation Park Dr
Oro Valley, AZ 85755-1963
2352 Savanna Woodlands
Green Lake, WI 54941-9607
535 SE Washington St
Hillsboro, OR 97123-4142
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260325001773 | OR | Practitioner - Nurse Practitioner | 6204310436 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17426-33 | WI | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 17426-33 | WI | Yes |
Addresses
Primary practice location
PO Box 97
Green Lake, WI 54941-0097
Mailing address
PO Box 97
Green Lake, WI 54941-0097
Phone (920) 229-0686
Other providers in Green Lake, WI
- Community Options, Inc.
- County of Green Lake
- County of Green Lake
- Shirley J. Dawson
- Holley Dornfeld
- Nancy Jean Gimenez
- Green Lake County Senior Transportation, Inc
- Green Lake Medical Clinic
- Green Lake Medical Clinic , S.C.
- Green Lake School District
All providers in Green Lake, WI · Psychiatric/Mental Health Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.