Healthcare Provider Details

I. General information

NPI: 1346673910
Provider Name (Legal Business Name): MELISSA THIBAULT MIKOTA APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LYNN THIBAULT ARNP

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 HOFFMAN BLVD
HOFFMAN ESTATES IL
60192-3722
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-685-4646
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133930
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010057
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010057
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: