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NPI Code Detail

MEDICARE: MRS. MELANIE ANN WYLIE RN MSN CNS APN

MEDICARE: MRS. MELANIE ANN WYLIE RN MSN CNS APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse309002368IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1041291221OTHERILRN LICENSE
2309002368OTHERILAPN LICENSE

General Provider Information

NPI Number : 1083735443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELANIE ANN WYLIE RN MSN CNS APN
Provider Business Mailing Address
First Line : 29 FOXMOOR DR
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-6729
Country : US
Telephone Number : 618-344-8986
Fax Number : 618-397-4368
Provider Business Practice Location Address
First Line : 12 N 64TH ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3809
Country : US
Telephone Number : 618-397-7145
Fax Number : 618-397-0093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 08/06/2009

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