Healthcare Provider Details

I. General information

NPI: 1821489568
Provider Name (Legal Business Name): MELINDA MARIE MONCRIEF NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 75TH ST SUITE 103
AURORA IL
60504-7925
US

IV. Provider business mailing address

15631 CHICAGO RD
SANDWICH IL
60548-4015
US

V. Phone/Fax

Practice location:
  • Phone: 630-375-1625
  • Fax: 630-375-1925
Mailing address:
  • Phone: 815-793-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: