Healthcare Provider Details

I. General information

NPI: 1194971846
Provider Name (Legal Business Name): MELISSA LOUISE PAROCHETTI CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 GILL ST SUITE#3
BLOOMINGTON IL
61704-3438
US

IV. Provider business mailing address

708 HENRY ST
PERU IL
61354-3128
US

V. Phone/Fax

Practice location:
  • Phone: 309-846-4716
  • Fax:
Mailing address:
  • Phone: 815-878-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number100399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: