Healthcare Provider Details

I. General information

NPI: 1497022586
Provider Name (Legal Business Name): MELISSA DAWN MACDONALD APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

IV. Provider business mailing address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3000
  • Fax: 309-243-3045
Mailing address:
  • Phone: 309-243-3000
  • Fax: 309-243-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007574
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: