Healthcare Provider Details

I. General information

NPI: 1154077915
Provider Name (Legal Business Name): MELISSA FISHER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD # LEVEL1
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD # LEVEL1
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7647
  • Fax: 847-535-7260
Mailing address:
  • Phone: 847-535-7647
  • Fax: 847-535-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2090025840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: