Healthcare Provider Details

I. General information

NPI: 1215846324
Provider Name (Legal Business Name): MELISSA KNORR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 E STATE ST
ROCKFORD IL
61108-2311
US

IV. Provider business mailing address

4107 ABBOTSFORD RD
ROCKFORD IL
61107-3629
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-4083
  • Fax: 815-226-3335
Mailing address:
  • Phone: 815-226-4083
  • Fax: 815-226-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number041368589
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: