Healthcare Provider Details

I. General information

NPI: 1710824214
Provider Name (Legal Business Name): MELINDA NOWAK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 WARRENVILLE RD STE 500
LISLE IL
60532-4356
US

IV. Provider business mailing address

1168 N DEL MAR DR
PALATINE IL
60067-2711
US

V. Phone/Fax

Practice location:
  • Phone: 866-902-0123
  • Fax:
Mailing address:
  • Phone: 847-226-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: