Healthcare Provider Details

I. General information

NPI: 1861303372
Provider Name (Legal Business Name): MELVINA N ESIAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 N MARINE DR
CHICAGO IL
60640-7860
US

IV. Provider business mailing address

7200 N RIDGE BLVD
CHICAGO IL
60645-2056
US

V. Phone/Fax

Practice location:
  • Phone: 773-600-5996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026077980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: