Healthcare Provider Details

I. General information

NPI: 1881726297
Provider Name (Legal Business Name): MELISSA ANNE SOELLNER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STATE ST MEMORIAL HOSPITAL
CHESTER IL
62233-1116
US

IV. Provider business mailing address

22 KNOLLWOOD DR
CHESTER IL
62233-1415
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4581
  • Fax: 618-826-1579
Mailing address:
  • Phone: 618-826-4581
  • Fax: 618-826-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164001250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: