Healthcare Provider Details

I. General information

NPI: 1447087606
Provider Name (Legal Business Name): MELANIE VANESSA HUTCHINSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 SOUTHLAWN PL
AURORA IL
60506-5351
US

IV. Provider business mailing address

1706 SOUTHLAWN PL
AURORA IL
60506-5351
US

V. Phone/Fax

Practice location:
  • Phone: 812-568-8875
  • Fax:
Mailing address:
  • Phone: 812-568-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041.516897
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: