Healthcare Provider Details

I. General information

NPI: 1851994933
Provider Name (Legal Business Name): MELISSA OLIVER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

3839 N WAYNE AVE APT G
CHICAGO IL
60613-7288
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-1400
  • Fax:
Mailing address:
  • Phone: 913-302-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209.022212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: