Healthcare Provider Details

I. General information

NPI: 1922450741
Provider Name (Legal Business Name): MELISSA FAYE TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 DAIMLER RD
ROCKFORD IL
61112-1019
US

IV. Provider business mailing address

2841 SWANSON PKWY
ROCKFORD IL
61109-1877
US

V. Phone/Fax

Practice location:
  • Phone: 815-977-4580
  • Fax:
Mailing address:
  • Phone: 912-541-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.031025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: